Intensity Modulated Radiation Therapy

Aetna covers IMRT for neoplasm diagnoses (ICD‑10 C00.0–D49.9 and Z51.0) when critical structures cannot be adequately protected with 3D conformal radiotherapy (including examples such as anal and anaplastic thyroid cancers), and permits fiducial marker placement and inter-/intrafraction image guidance when required; IMRT is not medically necessary for right breast cancer and is investigational for indications not specifically listed. Coverage requires meeting eviCore medical necessity criteria for IMRT, fiducials are covered only if the target is not clearly visible and bony anatomy is insufficient for alignment, and image guidance is covered only when clinically indicated to achieve the required localization/tracking.

"Selected cases of breast cancer where internal mammary nodes must be treated or more than 2 gantry angles are required to meet dose constraints."