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Brachytherapy After Breast-Conserving Surgery 6.01.30
Effective date
Dec 22, 2025
Identified
Jun 20, 2026
Summary
Excellus BlueCross BlueShield policy 6.01.30 covers interstitial or balloon brachytherapy of the breast as accelerated partial breast irradiation after breast-conserving surgery when either of two sets of criteria is met, and treats intra-operative breast radiotherapy and electronic brachytherapy as investigational. The 11/20/25 annual update made no changes to policy intent, termed code 0394T on 12/31/25, and added codes 77436, 77438 and 77439 effective 01/01/26, with code 77437 replacing 0394T. The current effective date of the policy is December 22, 2025.
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What to do
Action · 7 steps
01REQUIREMENTS: Already effective 01/01/26: Code 77437 replaces code 0394T, which was termed 12/31/25, and codes 77436, 77438 and 77439 were added.
02For accelerated partial breast irradiation by brachytherapy, the policy considers treatment medically appropriate when the patient meets all of these criteria: BRCA negative, age 50 years or greater, invasive ductal carcinoma measuring 2 cm or less (pT1 disease), negative margin widths of 2 mm or greater, no lymphovascular space invasion, and estrogen receptor positive.
03Alternatively, it is appropriate when the patient meets all of these criteria: low or intermediate nuclear grade, screening-detected ductal carcinoma in situ, measuring size of 2.5 cm or less, and negative margin widths of 3 mm or greater.
04Brachytherapy as a boost with breast-conserving surgery and whole-breast external beam radiation therapy is considered not medically necessary.
05Intra-operative breast radiotherapy and electronic brachytherapy are considered investigational.
06The code table marks 19294, 77424, 77425, 77436, 77437, 77438, 77439, 0395T and C9726 as (E/I) Experimental/Investigational.
07Services are contract dependent, and if a product does not cover a service, the medical policy criteria do not apply.
Codes mentioned
19294192961929719298773167731777318774247742577436774377743877439C9726Q3001C79.81Z85.3
Original notice
Brachytherapy After Breast-Conserving Surgery 6.01.30
excellusbcbs.com · Always check the source before changing claims.
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