Intensity-Modulated Radiotherapy

This policy covers intensity‑modulated radiotherapy (IMRT) for delivery of highly conformal external beam radiation to targets near sensitive normal tissues and for patients requiring multi‑step treatment planning and contouring, including pediatric solid tumors, ocular and skull‑base tumors, primary CNS/spine and metastatic spine/spinal cord disease, head and neck cancers, select breast cancer scenarios (including bilateral or unfavorable anatomy), craniospinal and hippocampal‑sparing whole brain indications, re‑irradiation when dose escalation is needed, and other complex tumor sites. Coverage requires documented multi‑step planning and adherence to prior dose and organ‑at‑risk constraints for re‑irradiation; stereotactic body radiation therapy (SBRT) for bone or metastatic/recurrent lesions is listed as investigational, and applicability is subject to coding changes and Medicare/Medicaid‑specific rules.

"Delivery of highly conformal external beam radiation (IMRT) to targets positioned near sensitive normal tissues."