Medical Policy Updates: Intensity-Modulated Radiotherapy of the Breast and Lung

Medical Policy Updates: Intensity-Modulated Radiotherapy of the Breast and Lung

11/30/2017

Radiotherapy is an important part of the treatment of breast and lung cancers. Intensity-modulated radiotherapy (IMRT) has been proposed as a method of radiotherapy that allows adequate radiotherapy to the tumor while reducing the radiation dose to surrounding normal tissues and critical structures.

On Oct. 18, 2017, an update was made to the policy criteria of CAM 80146 — Intensity-Modulated Radiotherapy of the Breast and Lung, to allow use of IMRT technology for the right or left side for breast cancer treatment. A portion of the revised policy reads as follows for BlueCross® BlueShield® of South Carolina and BlueChoice® HealthPlan members:

IMRT may be considered medically necessary as a technique to deliver whole-breast irradiation in patients receiving treatment for breast cancer after breast-conserving surgery when all the following conditions have been met:

  • Significant cardiac radiation exposure cannot be avoided using alternative radiation techniques. 

  • IMRT dosimetry demonstrates significantly reduced cardiac target volume radiation exposure.

Please remember medical necessity is not a guarantee of payment. Payment is subject to the member’s plan coverage, to include prior authorization requirements and benefits, at the time the service is performed. For complete information about CAM 80146, visit our Medical Policies page. You may also contact Provider Education by using the Provider Education Contact Form or by calling 803-264-4730

BlueCross® BlueShield® of South Carolina and BlueChoice® HealthPlan are independent licensees of the Blue Cross and Blue Shield Association.