HCPCS G6015 is officially defined as "Intensity modulated treatment delivery, single or multiple fields/arcs,via narrow spatially and temporally modulated beams, binary, dynamic mlc, per treatment session." HCPCS G6015 is referenced in 22 tracked payer policy changes from Anthem BCBS, BlueCross BlueShield of South Carolina, and 8 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS G6015 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Effective January 1, 2027, HealthKeepers, Inc. (Anthem HealthKeepers Plus Medicaid in Virginia) will discontinue reimbursement for 44 specific procedure codes to align with the Virginia Department of Medical Assistance Services (DMAS) fee schedule. The practice must stop billing these codes for dates of service on or after that date, as claims for discontinued codes will be denied or subject to adjustment and recovery.
BlueCross BlueShield of South Carolina and BlueChoice HealthPlan released 40 updated medical policies effective May 29, 2026. Most are routine annual reviews with no policy intent changes. Key billing updates include: new CPT codes 77062-77063 for breast cancer screening, replacement of CPT 99401-99402 with HCPCS S9943 for breastfeeding counseling, new compression pump CPT codes E0658/E0678-E0683 for lymphedema treatment, new CPT 0423U for pharmacogenetic testing, addition of HDR prostate brachytherapy as salvage therapy, new corneal collagen cross-linking products covered, and deletion of radiation therapy codes G6015-G6016.
BlueCross BlueShield of South Carolina and BlueChoice HealthPlan released 40 medical policy updates effective May 29, 2026. Key billing changes include: (1) CPT codes 77062 and 77063 added for breast cancer screening; (2) HCPCS code S9943 replaces CPT codes 99401/99402 for breastfeeding counseling; (3) Seven new E-series codes (E0658, E0678-E0683) added for compression pumps; (4) CPT code 0423U added for pharmacogenetic testing; (5) One new policy (CAM 404) for Transcranial Magnetic Stimulation; (6) CAM 80133 expanded to include HDR temporary prostate brachytherapy as salvage therapy; (7) CAM 80160 reorganized criteria for ECMO; (8) CAM 90328 expanded to include epithelium-on corneal collagen products.
Nevada Medicaid consolidated radiation therapy codes effective January 1, 2026. Terminated codes 77385, 77386, and 77014 are replaced by 77387 for imaging guidance, and HCPCS codes G6001-G6017 are consolidated into CPT codes 77402, 77407, and 77412 for treatment delivery.
Starting January 1, 2026, Health Net will require prior authorization for new radiation oncology CPT codes 77X05, 77X07, 77X08, and 77X09, while removing prior auth requirements for codes 77750, 79403, A9543, and A9590. Additionally, 17 obsolete radiation oncology codes are being deleted entirely and can no longer be billed.
Independence Blue Cross is updating MA09.020v to MA09.020w effective 01/01/2026, which removes coverage for Zevalin and Azedra radiopharmaceuticals from the eviCore utilization management program, adds four new CPT codes (77436-77439) for radiation therapy planning, removes 21 CPT/HCPCS codes, and revises three existing codes. Billing teams must update systems to reflect these code changes and discontinue billing for removed radiopharmaceutical codes.
Independence Blue Cross updated Medicare Advantage policy MA00.010av to MA00.010aw effective 01/01/2026, adding 39 new CPT/HCPCS codes across DME, laboratory, and radiology services, revising narratives for 8 existing codes, and terminating 23 codes. Billing teams must update systems to reflect these code additions, deletions, and narrative changes to ensure accurate reimbursement for PPO members.
Independence Blue Cross updated radiation therapy policy 09.00.56v to 09.00.56w effective 01/01/2026, adding four new CPT codes (77436-77439), removing 23 codes including radiopharmaceuticals and legacy procedure codes, and revising three CPT codes (77402, 77407, 77412). eviCore utilization management guidelines have been updated; refer to their website for current clinical guidelines.
Independence Administrators has reissued IMRT policy 09.00.17r with no substantive coverage changes, but five CPT/HCPCS codes (77014, G6001, G6002, G6015, G6016) have been terminated and removed effective 01/01/2026. Billing teams must immediately stop using these codes and verify which replacement codes apply to their IMRT claims.
UnitedHealthcare is streamlining radiation therapy prior authorization requirements effective January 1, 2026. Multiple existing codes will no longer require prior authorization, while new consolidated codes (77402, 77407, 77412, 77387-26) will be used for future prior auth requests for oncologic and hematologic diagnoses.
CMS discontinued radiation treatment codes 77014, 77385, 77386 and 17 G-codes for image-guidance services effective January 1, 2026, without direct replacements. Texas providers should bill using codes 77402, 77407, or 77412 instead, but claims may be denied until system updates are completed following rate hearing on April 24, 2026.
The Arkansas Department of Human Services has completed a review of the 2026 annual HCPCS and CPT procedure codes and will begin accepting the updated codes. New procedure codes are payable for dates of service on or after 1/1/2026, and the terminated codes listed in Section III are non-payable for dates of service after 12/31/2025. Drug procedure codes require National Drug Code (NDC) billing, except radiopharmaceuticals, vaccines and allergen immunotherapy.
UnitedHealthcare is streamlining radiation therapy prior authorization requirements effective January 1, 2026. Multiple existing codes for IMRT, IGRT, and Standard Radiation Therapy will no longer require prior authorization, while new consolidated codes (77402, 77407, 77412, 77387-26) will be used for prior authorization requests for treatments starting on or after that date.
Several prior authorization and coverage changes for Medicare Advantage plans and commercial products took effect October 1, 2025 and November 1, 2025, and both dates are already effective as of the analysis date of 2026-11-05. Some CPT/HCPCS codes changed from requiring prior authorization to being covered, including IMRT and stereotactic body radiation therapy codes. Prior authorization was added for CPT 25447 and for CPT 22585, 22840 and 27280 for Medicare Advantage plans, and it was removed for CPT 63663 and 63664.
BlueCross BlueShield of South Carolina updated 35 medical policies in May 2026, with key billing code changes for breast cancer screening and breastfeeding counseling, expanded coverage for lymphedema compression pumps, new salvage therapy coverage for prostate cancer, and introduction of a new Transcranial Magnetic Stimulation policy.
BlueCross BlueShield of South Carolina and BlueChoice HealthPlan updated or added medical policies in March 2026. Several code changes are effective 04/01/2026, including deletion of HCPCS G6015, G6016, C9751 and C9784, and additions of HCPCS C9810, C9817, A8005, A8006, A9294, C1607, L2221 and Q4398-Q4417, Q4420, plus CPT 0617U, 0620U, 0621U, 0628U and 0630U. CAM 126 Vitamin D Testing updates testing frequency to once per six months for symptomatic individuals who test negative at their previous test or who tested positive and began supplementation, and CAM 242 Esophageal Pathology Testing removes CPT codes 88305, 88160, 88112 and 88312.
Independence Administrators reissued IMRT policy 09.00.17r with no substantive changes to medical necessity criteria or coverage guidelines. Five CPT/HCPCS codes (77014, G6001, G6002, G6015, G6016) have been terminated and removed from the policy effective 01/01/2026 due to annual CPT code updates. Billing teams must remove these codes from system configurations and encounter forms to prevent claim denials.
Intensity-modulated radiotherapy (IMRT) for breast cancer may be considered medically necessary to deliver whole-breast irradiation in individuals with left-sided breast cancer after breast-conserving surgery when significant cardiac radiation exposure cannot be avoided with alternative radiotherapy and IMRT dosimetry shows significantly reduced cardiac target volume exposure. IMRT may also be considered medically necessary for individuals with large breasts when 3D conformal radiotherapy produces hot spots greater than 10% of target dose that IMRT can avoid. IMRT for lung cancer may be considered medically necessary when radiotherapy is given with curative intent, 3D conformal radiotherapy would expose more than 35% of normal lung tissue to more than 20 Gy (V20), and IMRT reduces the V20 to at least 10% below the 3D plan; partial-breast IMRT, chest wall IMRT after mastectomy and palliative lung IMRT are investigational. A 10/01/2025 update added ICD-10 codes C50.A0, C50.A1 and C50.A2 for malignant inflammatory neoplasm of breast.
Intensity-modulated radiotherapy (IMRT) may be considered medically necessary in the treatment of localized prostate cancer. After radical prostatectomy, IMRT may be considered medically necessary as adjuvant therapy when adverse pathologic findings are present or PSA remains persistently detectable, or as salvage therapy when there is biochemical or local recurrence without distant metastatic disease. IMRT is considered investigational for prostate cancer when these criteria are not met.
IMRT may be considered medically necessary for individuals with malignant or benign brain tumors when the tumor is proximate to organs at risk (brain stem, spinal cord, cochlea, and eye structures) and 3-dimensional conformal radiotherapy planning cannot meet dose-volume constraints for normal tissue tolerance. Hippocampal-avoiding IMRT may be considered medically necessary for individuals with brain tumor metastases outside a 5-mm margin around either hippocampus and expected survival of 4 months or more. IMRT is considered investigational for tumors of the central nervous system for all other indications.
A 09/15/2025 update changed the description of intensity modulators and radiotherapy treatment planning systems, and the policy statements were unchanged. Intensity-modulated radiotherapy may be considered medically necessary for head and neck cancers, which the policy defines as cancers of the oral cavity and lip, larynx, hypopharynx, oropharynx, nasopharynx, paranasal sinuses and nasal cavity, salivary glands, and occult primaries in the head and neck region. For thyroid cancer, it may be considered medically necessary when the cancer is in close proximity to organs at risk (esophagus, salivary glands, and spinal cord) and 3D conformal radiotherapy planning is not able to meet dose volume constraints for normal tissue tolerance. Intensity-modulated radiotherapy is investigational for thyroid cancers that do not meet these criteria.
Intensity-modulated radiotherapy may be considered medically necessary as an approach to delivering radiotherapy for individuals with cancer of the anus and anal canal. When dosimetric planning with standard 3D conformal radiotherapy predicts that the radiation dose to an adjacent organ would result in unacceptable normal tissue toxicity, IMRT may be considered medically necessary for cancer of the abdomen and pelvis, including stomach, hepatobiliary tract, pancreas, esophageal cancer, rectal locations, and gynecologic tumors (cervical, endometrial, and vulvar cancers). IMRT is investigational for all other uses in the abdomen and pelvis. For IMRT to provide outcomes superior to 3D-CRT, there must be a clinically meaningful decrease in radiation exposure to normal structures compared with 3D-CRT.
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