CG-THER-RAD-07 Intravascular Coronary and Non-Coronary Brachytherapy

This policy addresses intravascular brachytherapy (radiation delivered inside blood vessels), specifically intravascular coronary brachytherapy (ICB) for treating in-stent restenosis. ICB is covered only when used for coronary in-stent restenosis in individuals with persistent myocardial ischemia symptoms despite guideline-directed medical therapy or who have a contraindication to such therapy. It is not covered for any other coronary indications when these criteria are not met, and intravascular non-coronary brachytherapy is not covered for any indication.

"Intravascular coronary brachytherapy is consideredmedically necessaryas a treatment of in-stent restenosis when individuals have persistent symptoms of myocardial ischemia despite guideline-directe..."

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