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PAYER POLICY CHANGES

C9794 Insurance Policy Changes

HCPCS C9794 is officially defined as "Therapeutic radiology simulation-aided field setting; complex, including acquisition of pet and ct imaging data required for radiopharmaceutical-directed radiation therapy treatment planning (i.e., modeling)." HCPCS C9794 is referenced in 1 tracked payer policy change from Blue Cross Blue Shield of North Dakota. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS C9794 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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REFERENCE DATA

Payers with rules2
Payers requiring prior auth2
  • Centene · Effective December 31, 2025

    Prior authorization required

    Sunshine Health Title XIX, Title XXI, Managed Medical Assistance CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does AmeriHealth Caritas require prior authorization for C9794?

AmeriHealth Caritas lists C9794 on AmeriHealth Caritas Louisiana prior authorization service list for medicaid managed plans. Verify with the payer before scheduling.

Does Centene require prior authorization for C9794?

Centene lists C9794 on Sunshine Health Title XIX, Title XXI, Managed Medical Assistance CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect HCPCS C9794?

There are 1 tracked policy change affecting HCPCS C9794, including updates from Blue Cross Blue Shield of North Dakota. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS C9794?

Payers that have issued tracked updates for HCPCS C9794 include: Blue Cross Blue Shield of North Dakota.

How do I get notified when HCPCS C9794 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS C9794. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for HCPCS C9794?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

See every payer rule for C9794

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for C9794 in one place.

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