Based on reports from members, ASTRO is tracking early 2026 prior authorization denials and has identified recurring issues with CPT 77412 (Level 3) and CPT 77387-26 (IGRT). Denials for 77412 have largely stemmed from payer interpretations limiting the code to treatment of multiple anatomical sites, rather than multiple isocenters for a single site, as well as global application of fraction limits and inconsistent coverage for clinically necessary scenarios such as multiple joints or breast treatments using active motion management. EviCore has noted that non-specific documentation (“DIBH” alone) and inappropriate use of “urgent” designations may contribute to denials.

Separately, CPT 77387-26 denials have been issued based on claims that IGRT is bundled with treatment delivery or that the professional component is not separately payable in hospital settings, resulting in inconsistent denial rationales across both freestanding and hospital-based facilities. To submit an inappropriate denial, please email Emilio Beatley or Alex Costa.