Brachytherapy (CPB 0371, reviewed 2026-05-20)

By May 20, 2026: (1) Billing team must update claim submission rules in billing software to DENY any claims for CPT codes 0394T and 0395T (electronic brachytherapy) and endovascular brachytherapy (CPT 37224 for re-stenosis indications) — these are now explicitly non-covered as experimental/investigational. (2) Prior to claim submission, verify all brachytherapy claims against EviCore Healthcare Radiation Therapy Clinical Guidelines for medical necessity. (3) For breast brachytherapy claims using CPT 19296, 19297, 19298, ensure proper documentation of placement timing relative to partial mastectomy. (4) For prostate brachytherapy (CPT 55875, 55876), confirm medical necessity per EviCore guidelines and document that brachytherapy is not being billed as ProstRcision (combination approach not proven superior). (5) Update claim scrubbing logic to flag any submission of C2616, C2643 (yttrium-90, cesium-131 sources) or other radioelement sources (C1716-C1717, C2634-C2642, C2698-C2699) without corresponding approved placement CPT codes. (6) Provider education team must communicate to all ordering physicians that electronic brachytherapy systems (AccuBoost, Xoft Axxent eBx) are NOT covered for any indication including breast cancer and dermatologic uses. Failure to implement these controls will result in claim denials and potential compliance violations.