77316 CPT® code: payer coverage and prior authorization9 of 17 payer prior-auth lists that name 77316 require prior authorization or set conditions: Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Texas, Cigna, HealthSpring, Molina Healthcare of California, Molina Healthcare of Illinois, Molina Healthcare of Michigan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Cigna | ACA/IFP | All | prior auth required | May be delegated to eviCore for some clients | Jan 1, 2015 | Master Precertification List (For Health Care Providers) |
| Cigna | Basic Standard | All | prior auth required | May be delegated to eviCore for some clients | Jan 1, 2015 | Master Precertification List (For Health Care Providers) |
| Cigna | Complete/PHS+/Preferred | All | prior auth required | May be delegated to eviCore for some clients | Jan 1, 2015 | Master Precertification List (For Health Care Providers) |
| Blue Cross and Blue Shield of Illinois | Blue Cross Community Health Plans (BCCHP), Illinois Medicaid | IL | prior auth required | Carelon-managed | Aug 1, 2025 | Illinois Medicaid Prior Authorization Code List, Effective 10/1/2026 |
| Blue Cross and Blue Shield of Texas | Texas PA exemption (gold card), outpatient, fully insured | TX | prior auth required | Gold-card exemption available | Jul 1, 2026 | BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range) |
| HealthSpring | Medicare Advantage | All | prior auth required | Jan 1, 2025 | 2026 Q4 Prior Authorization List | |
| Molina Healthcare of California | Medicaid | CA | prior auth required | Apr 1, 2026 | Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026 | |
| Molina Healthcare of Illinois | Medicaid | IL | prior auth required | Apr 1, 2023 | Molina Healthcare of Illinois Codification Grid Q3 2026 | |
| Molina Healthcare of Michigan | Medicaid | MI | prior auth under conditions | adults via Evolent; no PA for pediatrics | Jul 1, 2026 | Molina Healthcare of Michigan PA Matrix 2026-Q3 |
77316 appears in 16 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross NC, Centene.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Brachytherapy (0371) | covered if criteria are met (range 77316-77318) | May 20, 2026 | payer document |
| Aetna | Cemiplimab-rwlc (Libtayo) (0942) | listed, no stance (range 77261-77799) | Jun 12, 2026 | payer document |
| Aetna | Growth Hormone (GH) and Growth Hormone Antagonists (0170) | listed, no stance (range 77261-77799) | Jun 26, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Selected Childhood Solid Tumors (0496) | listed, no stance (range 77261-77799) | Aug 6, 2026 | payer document |
| Aetna | Infertility (0327) | listed, no stance (range 77261-77790) | Jul 16, 2026 | payer document |
| Aetna | Intraoperative Radiation Therapy (IORT) (0721) | listed, no stance (range 77300-77399) | Oct 20, 2025 | payer document |
| Aetna | Stereolithographic Models and Implants (0613) | listed, no stance | Sep 3, 2026 | payer document |
| Aetna | Strontium Chloride Sr-89 (0361) | listed, no stance (range 77261-77525) | Jan 9, 2026 | payer document |
| Aetna | Transrectal Ultrasound (0001) | listed, no stance | Mar 5, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Accelerated Breast Irradiation And Brachytherapy Boost After Breastconserving Surgery For Earlystage Breast Cancer | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Brachytherapy For Clinically Localized Prostate Cancer Using Permanently Implanted Seeds (L.8.01.417) | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Endobronchial Brachytherapy (L.8.03.404) | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Highdose Rate Temporary Prostate Brachytherapy | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Intracavitary Balloon Catheter Brain Brachytherapy For Malignant Gliomas Or Metastasis To The Brain (L.8.01.418) | unproven / investigational | payer document | |
| Blue Cross NC | Radiation Therapy Services | listed, no stance | Nov 1, 2025 | payer document |
| Centene | Radiation Therapy for Skin Cancer (CP.MP.251) | covered if criteria are met | Aug 1, 2026 | payer document |
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.