77399 CPT® code: payer coverage and prior authorization50 of 52 payer prior-auth lists that name 77399 require prior authorization or set conditions: Cigna, HealthSpring, Humana, Molina Complete Care (Virginia), Molina Healthcare of California, Molina Healthcare of Idaho, Molina Healthcare of Illinois, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, Molina Healthcare of Nevada, Molina Healthcare of New Mexico, Molina Healthcare of Ohio, Molina Healthcare of Texas, Neighborhood Health Partnership, Oxford Health Plans, Passport by Molina Healthcare (Kentucky), Rocky Mountain Health Plans, Surest, UnitedHealthcare, and others.
77399 appears in 25 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, BlueCross BlueShield of South Carolina, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Regence, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Antiemetic Therapy (0724) | listed, no stance (range 77371-77425) | Jul 17, 2026 | payer document |
| Aetna | Cemiplimab-rwlc (Libtayo) (0942) | listed, no stance (range 77261-77799) | Jun 12, 2026 | payer document |
| Aetna | Enfortumab Vedotin-ejfv (Padcev) (0967) | listed, no stance (range 77399-77417) | Oct 9, 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 | Strontium Chloride Sr-89 (0361) | listed, no stance (range 77261-77525) | Jan 9, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Chargedparticle Proton Or Helium Ion Radiotherapy For Neoplastic Conditions | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Realtime Intrafraction Motion Management During Radiation Therapy (L.2.03.401) | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Mississippi | Stereotactic Radiosurgery And Stereotactic Body Radiotherapy | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Rhode Island | DRAFT Radioembolization of Primary and Metastatic Tumors of the Liver Medicare Advantage Plans and Commercial Products | listed, no stance | Jul 16, 2025 | payer document |
| Blue Cross & Blue Shield of Rhode Island | Radioembolization for Primary and Metastatic Tumors of the Liver Medicare Advantage Plans and Commercial Products | listed, no stance | Aug 19, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy (CAM 60110) | listed, no stance | Sep 1, 2025 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Radioembolization for Primary and Metastatic Tumors of the Liver (RAD601.047) | listed, no stance | Nov 15, 2025 | payer document |
| Regence | Charged-Particle (Proton) Radiotherapy (Medicine 49) | listed, no stance | Aug 1, 2025 | payer document |
| UnitedHealthcare | Radiation Therapy: Fractionation, Image-Guidance, and Special Services (2026T0613L) | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Radiation Therapy: Fractionation, Image-Guidance, and Special Services (CS179.H) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Radiation Therapy: Fractionation, Image-Guidance, and Special Services (for Idaho Only) (CS179ID.C) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Radiation Therapy: Fractionation, Image-Guidance, and Special Services (for Kansas Only) (CS179KS.02) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Radiation Therapy: Fractionation, Image-Guidance, and Special Services (for Kentucky Only) (CS179KY.04) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Radiation Therapy: Fractionation, Image-Guidance, and Special Services (for New Jersey Only) (CS179NJ.E) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Radiation Therapy: Fractionation, Image-Guidance, and Special Services (for New Mexico Only) (CS179NM.C) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Radiation Therapy: Fractionation, Image-Guidance, and Special Services (for Ohio Only) (CS179OH.E) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Radiation and Oncologic Procedures (MMP077.17) Radiation Therapy Special/Associated Services | listed, no stance | Sep 1, 2026 | payer document |
Prior authorization required or conditional in FL, KY, VT, WV, WY.
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.