Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
AetnaAll Plans · Coverage · Medical Policy · Oncology, Radiation Oncology, General Surgery +1 moreMedium impact

Intraoperative Radiation Therapy (IORT) (CPB 0721, reviewed 2026-10-15)

Effective date
Not stated in the notice
Identified
Oct 22, 2026

Summary

Aetna Clinical Policy Bulletin 0721 sets Aetna's coverage rules for intraoperative radiation therapy (IORT). Aetna considers IORT medically necessary for cervical cancer, colorectal cancer, soft tissue sarcoma (including retroperitoneal sarcoma) and uterine cancer, and considers single-fraction electron-beam IORT at the time of lumpectomy medically necessary for breast cancer when the selection criteria are met. Aetna considers IORT experimental, investigational or unproven for brain tumors and brain metastasis, cholangiocarcinoma, conjunctival neoplasms, gastric cancer, glioma, head and neck cancers, osteosarcoma, pancreatic cancer, prostate cancer, renal cell carcinoma, spinal and vertebral metastases, sporadic renal angiomyolipoma and thymoma, and notes that this list is not all-inclusive.

Get alerts when payers change rules like this one

We check Aetna and other payers every day and email you when a change matches your specialty and state.

Get Aetna alertsPolicy Monitoring is free. No card required.

What to do

Action · 4 steps
01Bill CPT 77424, 77425 or 77469 for IORT only when the selection criteria are met and documented: for breast cancer, a documented diagnosis of early stage (0, I or II) breast cancer, negative lymph nodes, technically clear surgical margins, and a tumor 5 cm or less in diameter.
02The covered ICD-10 codes when the criteria are met include C18.0-C21.8 (colorectal), C46.1, C49.4-C49.5 (retroperitoneal sarcoma), C50.011-C50.929 and D05.00-D05.92 (breast), and C53.0-C54.9 (cervix and uterus).
03Do not bill CPT 0735T for the indications listed in the bulletin, because it is not covered for those indications.
04For ICD-10 codes tied to the listed experimental indications, such as C25.0-C25.9 (pancreatic cancer) and C61 (prostate cancer), IORT is not covered because Aetna considers it experimental, investigational or unproven for those indications.

Codes mentioned

774247742577469192941930119302C46.1C49.0C61C37C73C76.0C79.31D02.3D17.71

Original notice

Intraoperative Radiation Therapy (IORT) (CPB 0721, reviewed 2026-10-15)
aetna.com · Always check the source before changing claims.
View original ↗

Related changes

See all Aetna changes →
Intraoperative Radiation Therapy (IORT) (CPB 0721, reviewed 2025-10-20)MediumNo effective date · Medical PolicyHematopoietic Cell Transplantation for Solid Tumors in Adults (CPB 0811, reviewed 2025-12-03)MediumNo effective date · Medical PolicyDostarlimab-gxly (Jemperli) (CPB 0993, reviewed 2026-01-27)MediumNo effective date · Medical PolicyPaclitaxel, Albumin-Bound (CPB 0834, reviewed 2026-05-28)MediumNo effective date · Medical PolicyBrowse every Aetna change in the policy list

Related policy hubs

Aetna policiesOncologyRadiation OncologyGeneral SurgeryOB-GYNCode 77424Code 77425Code 77469Code 19294Code 19301Code 19302Code C46.1Code C49.0Code C61Code C37Code C73Code C76.0Code C79.31Code D02.3Code D17.71

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account