Effective for dates of service on and after February 9, 2020, the following updates will apply to the AIM Radiation Therapy Clinical Appropriateness Guidelines.


  • Special Treatment Procedure and Special Physics Consult
    • Removed oral cone endocavitary indication


  • Intensity Modulated Radiation Therapy (IMRT), Stereotactic Radiosurgery (SRS) or Stereotactic Body Radiotherapy (SBRT) for bone metastases
    • Broadened description of adjacent normal tissues which may be of concern.


  • Single fraction treatment
    • Removed poor performance status criteria


  • Central Nervous System cancers
    • Added evidence review


  • Spine Lesions; Primary or Metastatic Lesions of the Spine, Metastatic Lesions in the Lung
    • Added note calling out separate criteria for curative intent treatment of extracranial oligometastatic disease.


  • SBRT in the treatment of extracranial oligometastatic disease
    • Added new section with discussion and indications


  • Prostate cancer – hypofractionation
    • Added fractionation guideline with EBRT/IMRT.


  • Prostate cancer – postoperative radiotherapy and SBRT
    • Added indication based on ASTRO/ASCO/AUA recommendation


  • Prostate cancer – use of hydrogel spacer
    • Added discussion and medical necessity statement about hydrogel spacers for prostate irradiation


  • CPT code changes
    • Added 77316, 77295 and 55874
    • Removed 77427


Featured In:
November 2019 Anthem Provider News - Virginia