ASTRO continues to track early 2026 prior authorization denials and has identified recurring issues with CPT 77412 (Level 3) and CPT 77387-26 (IGRT).  ASTRO has contacted EviCore for clearance and guidance for these denials. EviCore has noted that non-specific documentation (“DIBH” alone) and inappropriate use of “urgent” designations may contribute to denials. EviCore has provided the following guidelines as sufficient documentation: 
To support an approval for 77412 due to active motion management, eviCore recommends that providers include clear, explicit detail addressing the following elements:

1. Medical necessity for motion management
2. Real-time monitoring or gating system used: Identify the specific system or technology used for intrafraction motion tracking
3. Workflow or parameters used for active motion management: Describe how motion is monitored during treatment, including thresholds, tolerance levels, and patient-specific setup.
4. Description of respiratory monitoring and tracking during treatment: Clarify whether monitoring is continuous, how motion data is acquired, and how the therapist is alerted to deviations.
5. Methodology determining beam-on and beam-off: State the criteria used to gate delivery, including what triggers beam-off events.

ASTRO Health Policy leadership are organizing another meeting with eviCore to discuss the burdensome documentation requirements and inappropriate denials of 77412. Members are also being denied the professional component of image guidance 77387 due to an incorrect edit in the United Healthcare system. ASTRO is working with UHC to correct this problem. To submit an inappropriate denial, please email Emilio Beatley or Alex Costa.