Prior Authorization
Aetna Prior Authorization for CPT 77523
Proton beam radiation therapy · Standard commercial plans
Source
Aetna Participating Provider Precertification List 2026 (Updated May 1, 2026)Not medical advice. PA policies change frequently. Always confirm against the payer's current policy before submitting. d3rx pulls directly from publicly published policy PDFs and refreshes daily.
Clinical criteria
Aetna lists this code under Services that require precertification: Proton beam radiotherapy, and refers providers to Special programs: Radiation oncology for program details. Product, place-of-service, and funding exceptions may apply. Evidence: PDF p.9, Services that require precertification, item 31; also points to Special programs: Radiation oncology.
Documentation checklist
- ✓Completed precertification request
- ✓Medical records requested for Aetna or delegated radiation oncology review
2026 Medicare rate for CPT 77523
CPT 77523 is not priced under the 2026 Medicare Physician Fee Schedule (status C) — drugs/biologicals price under ASP and lab tests under the CLFS. See the CPT 77523 code page for pricing detail.
How to submit the PA
- 1Verify the requirement against the current clinical policy linked above.
- 2Gather documentation: Completed precertification request, Medical records requested for Aetna or delegated radiation oncology review.
- 3Submit via the payer's provider portal or designated PA channel.
- 4Document the reference number and follow up within 5 business days if no determination is received.
FAQ
- Does Aetna require prior authorization for CPT 77523?
- Yes. Aetna requires prior authorization for CPT 77523 (Proton beam radiation therapy) under Standard commercial plans per its published clinical policy.
- What documentation does Aetna require for CPT 77523?
- Completed precertification request; Medical records requested for Aetna or delegated radiation oncology review
- What if Aetna denies the PA for CPT 77523?
- Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.
Other Aetna PA lookups
CPT 77523 prior authorization by payer
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