79445 CPT® code: payer coverage and prior authorization28 of 28 payer prior-auth lists that name 79445 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas, Neighborhood Health Partnership, Oxford Health Plans, Rocky Mountain Health Plans, Surest, UnitedHealthcare, UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| 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) |
| Neighborhood Health Partnership | Neighborhood Health Partnership | FL | prior auth under conditions | only with dx C34.00, C34.01, C34.02, C34.10, C34.11, C34.12 | Sep 1, 2026 | Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026 |
| Oxford Health Plans | Oxford Health Plans | All | prior auth under conditions | only with dx C34.00, C34.01, C34.02, C34.10, C34.11, C34.12 | Oct 1, 2026 | Prior Authorization Requirements for Oxford Effective October 1, 2026 |
| Rocky Mountain Health Plans | Rocky Mountain Health Plans CHP+ | CO | prior auth under conditions | only with dx C34.00, C34.01, C34.02, C34.10, C34.11, C34.12 | Oct 1, 2026 | Rocky Mountain Children’s Health Plan - prior authorization Effective October 1, 2026 |
| Rocky Mountain Health Plans | Rocky Mountain Health Plans Prime / RAE | CO | prior auth under conditions | only with dx C34.00, C34.01, C34.02, C34.10, C34.11, C34.12 | Oct 1, 2026 | Rocky Mountain Health Plans PRIME Effective October 1, 2026 |
| Rocky Mountain Health Plans | Rocky Mountain Medicare Advantage D-SNP | CO | prior auth required | Feb 1, 2025 | Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025 | |
| Surest | Surest health plans | All | prior auth required | Oct 1, 2026 | Prior Authorization Requirements for Surest Effective October 1, 2026 | |
| UnitedHealthcare | Preferred Care Network and Preferred Care Partners of Florida | FL | prior auth required | Oct 1, 2026 | Prior authorization requirements for Preferred Care Network and Preferred Care Partners of Florida Effective October 1, 2026 | |
| UnitedHealthcare | UnitedHealthcare Commercial | All | prior auth under conditions | only with dx C34.00, C34.01, C34.02, C34.10, C34.11, C34.12 | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare commercial plans Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Complete (Individual & Family plans) | All | prior auth required | Sep 1, 2026 | Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026 | |
| UnitedHealthcare | UnitedHealthcare Individual Exchange plans | All | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026 | |
| UnitedHealthcare | UnitedHealthcare Medicare Advantage, Peoples Health and Dual Complete (D-SNP) | All | prior auth required | Excluded plans: Erickson Advantage and Massachusetts DSNP (includes MA SCO OneCare) | Oct 1, 2026 | UnitedHealthcare® Medicare Advantage/ Peoples Health Plans prior authorization requirements Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Mid-Atlantic Health Plans | All | prior auth under conditions | only with dx C34.00, C34.01, C34.02, C34.10, C34.11, C34.12 | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Mid-Atlantic Health Plans Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare of the River Valley | All | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare of the River Valley Effective October 1, 2026 | |
| UnitedHealthcare Community Plan | Louisiana Medicaid (Healthy Louisiana) | LA | prior auth required | Jan 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Louisiana | |
| UnitedHealthcare Community Plan | Maryland HealthChoice | MD | prior auth under conditions | only with dx C34.00, C34.01, C34.02, C34.10, C34.11, C34.12 | Sep 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Maryland Effective September 1, 2026 |
| UnitedHealthcare Community Plan | Mississippi CHIP | MS | prior auth required | Apr 1, 2025 | Prior authorization requirements for Mississippi Children’s Health Insurance Program Effective Apr. 1, 2025 | |
| UnitedHealthcare Community Plan | MississippiCAN | MS | prior auth required | Apr 1, 2025 | Prior authorization requirements for UnitedHealthcare Community Plan of Mississippi – Mississippi Coordinated Access Network (MississippiCAN) Effective Apr. 1, 2025 | |
| UnitedHealthcare Community Plan | New Jersey FamilyCare | NJ | prior auth under conditions | only with dx C34.00, C34.01, C34.02, C34.10, C34.11, C34.12 | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of New Jersey Effective October 1, 2026 General Information This list contains prior authorization requirements for participating U |
| UnitedHealthcare Community Plan | New Mexico Turquoise Care | NM | prior auth under conditions | only with dx C34.00, C34.01, C34.02, C34.10, C34.11, C34.12 | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of New Mexico Effective October 1, 2026 |
| UnitedHealthcare Community Plan | Ohio Medicaid | OH | prior auth required | Nov 1, 2025 | Prior authorization requirements for Ohio Medicaid Effective November 1, 2025 General Information This list contains prior authorization requirements for participating UnitedHealthcare Community Plan | |
| UnitedHealthcare Community Plan | Rhode Island Medicaid | RI | prior auth under conditions | only with dx C34.00, C34.01, C34.02, C34.10, C34.11, C34.12 | May 1, 2026 | Prior authorization requirements for Rhode Island Medicaid Effective May 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan of Rhode Island h |
| UnitedHealthcare Community Plan | UnitedHealthcare Community Plan of Florida | FL | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHeathcare Community Plan of Florida Effective October 1, 2026 | |
| UnitedHealthcare Community Plan | UnitedHealthcare Community Plan of Kentucky | KY | prior auth under conditions | only with dx C79.51, C79.52 | Jul 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026 |
| UnitedHealthcare Community Plan | Virginia Cardinal Care LTSS | VA | prior auth under conditions | * Prior Auth only required to manage fractionation when requested for the following diagnosis codes/ranges: Applicable ICD10 codes for cancer types in scope for Hypofractionation: | Oct 1, 2026 | Prior authorization requirements for Virginia Cardinal Care LTSS Effective October 1, 2026 |
| UnitedHealthcare Community Plan | Virginia Cardinal Care Medicaid | VA | prior auth under conditions | * Prior Auth only required to manage fractionation when requested for the following diagnosis codes/ranges: Applicable ICD10 codes for cancer types in scope for Hypofractionation: | Oct 1, 2026 | Prior authorization requirements for Virginia Cardinal Care Effective October 1, 2026 |
| UnitedHealthcare Community Plan | Washington Apple Health | WA | prior auth under conditions | only with dx C34.00, C34.01, C34.02, C34.10, C34.11, C34.12 | Oct 1, 2026 | Prior authorization requirements for the UnitedHealthcare Community Plan of Washington Effective April 1, 2023 |
| UnitedHealthcare Community Plan | Wisconsin BadgerCare Plus and Medicaid SSI | WI | prior auth under conditions | only with dx C34.00, C34.01, C34.02, C34.10, C34.11, C34.12 | Sep 1, 2026 | Prior authorization requirements for Wisconsin Medicaid Effective September 1, 2026 General Information This list contains prior authorization requirements for participating UnitedHealthcare Community |
79445 appears in 19 coverage policies from Aetna, Blue Cross NC, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Liver and Other Neoplasms - Treatment Approaches (0268) | not covered | Sep 18, 2026 | payer document |
| Aetna | Tumor Scintigraphy (0168) | not covered | Mar 27, 2026 | payer document |
| Blue Cross NC | Radioembolization for Primary and Metastatic Tumors of the Liver | listed, no stance | May 1, 2026 | 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 |
| Premera Blue Cross | Radioembolization for Primary and Metastatic Tumors of the Liver (8.01.521) Page | 3 of 26 | ∞ | listed, no stance | Sep 7, 2026 | payer document |
| UnitedHealthcare | Radiation and Oncologic Procedures (MMP077.17) Implantable Beta-Emitting Microspheres for Treatment of Malignant Tumors | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Transarterial Radioembolization (TARE)/ Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (CS060PA.O) | listed, no stance | Feb 1, 2026 | payer document |
| UnitedHealthcare | Transarterial Radioembolization (TARE)/ Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (CS060NM.C) | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Transarterial Radioembolization (TARE)/ Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (CS060NJ.M) | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Transarterial Radioembolization (TARE)/ Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (CS060LA.M) | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Transarterial Radioembolization (TARE)/ Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (CS060.O) | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Transarterial Radioembolization (TARE)/ Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (CS060NE.O) | listed, no stance | Feb 1, 2026 | payer document |
| UnitedHealthcare | Transarterial Radioembolization (TARE)/ Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (2026T0445BB) | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Transarterial Radioembolization (TARE)/ Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (for North Carolina Only) (CSNCT0445.03) | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Transarterial Radioembolization (TARE)/Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (for Idaho Only) (CS060ID.B) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Transarterial Radioembolization (TARE)/Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (for Kansas Only) (CS060KS.02) | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Transarterial Radioembolization (TARE)/Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (for Kentucky Only) (CS060KY.10) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Transarterial Radioembolization (TARE)/Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (for Ohio Only) (CS060OH.D) | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Transarterial Radioembolization (TARE)/Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (for Tennessee Only) (CS060TN.N) | listed, no stance | Jan 1, 2026 | payer document |
Prior authorization required or conditional in KY.
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.