`C9726` Rxt breast appl place/remov

Placement and removal (if performed) of applicator into breast for intraoperative radiation therapy, add-on to primary breast procedure

Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 2 units per day (clinical), rationale: Clinical: CMS Workgroup
Outpatient hospital: max 2 units per day (clinical), rationale: Anatomic Consideration

Payer policies and prior authorization for C9726

3 of 5 payer prior-auth lists that name C9726 require prior authorization or set conditions: Cigna.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Cigna	ACA/IFP	All	prior auth required	May be delegated to eviCore for some clients	Aug 1, 2012	Master Precertification List (For Health Care Providers)
Cigna	Basic Standard	All	prior auth required	May be delegated to eviCore for some clients	Aug 1, 2012	Master Precertification List (For Health Care Providers)
Cigna	Complete/PHS+/Preferred	All	prior auth required	May be delegated to eviCore for some clients	Aug 1, 2012	Master Precertification List (For Health Care Providers)

Payer coverage policies that name C9726

C9726 appears in 2 coverage policies from Aetna, BlueCross BlueShield of South Carolina.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Brachytherapy (0371)	covered if criteria are met	May 20, 2026	payer document
BlueCross BlueShield of South Carolina	Breast Cancer Radiation Oncology (CAM 381)	listed, no stance	Apr 1, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in WA.

AZ: $1796.27 (outpatient_hospital), effective Oct 1, 2013
IN: $0.00 (professional, Advanced Practice Nurse (85%), non-facility), effective Sep 21, 2018
KY: $0.00 (asc), effective Jan 1, 2026
MA: $0.00 (asc), effective May 1, 2026
ND: $0.00 (physician), effective Aug 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

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.

C9726 Rxt breast appl place/remov

Medically Unlikely Edits (effective October 1, 2026)

Payer policies and prior authorization for C9726

Payer coverage policies that name C9726

Medicaid fee-for-service

`C9726` Rxt breast appl place/remov