Intensity Modulated Radiation Therapy - Medicare Advantage

This policy covers intensity‑modulated radiation therapy (IMRT) — including VMAT, helical TomoTherapy, MLC‑based IMRT and related procedures such as prostate rectal spacer implantation — for delivery of highly conformal external beam radiotherapy to maximize tumor dose while sparing normal tissues. Coverage applies to patients with tumor indications requiring precise contouring (including prostate cancer with biodegradable rectal spacers) and is limited to Medicare determinations within the Palmetto GBA MAC jurisdictions (AL, GA, TN, NC, SC, VA, WV) or as governed by applicable NCDs/LCDs (LCD L39553/LCA A59350); services must meet the MAC/LCD reasonable‑and‑necessary criteria and services not meeting those criteria (e.g., gross posterior extraprostatic extension) are not covered.

"Follow the documentation requirements specified in the referenced MAC LCD L39553 / LCA A59350 (Radiation Therapies) for medical records, test results, and clinical notes necessary to support medica..."