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