Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy - Medicare Advantage

This Humana Medicare Advantage policy covers stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT)—high‑dose, image‑guided 3‑D localized radiotherapies—for intracranial lesions (e.g., AVMs, aneurysms, benign and malignant brain tumors, vestibular schwannoma) and extracranial tumors (e.g., adrenal, bone/spine, kidney, liver, lung, prostate), and also addresses transperineal biodegradable prostate‑rectal spacer placement to reduce rectal dose during prostate radiotherapy. Coverage and medical necessity follow the applicable MAC LCD (L39553); SRS/SBRT fractionation is generally limited to 1–5 fractions (SBRT entire course not to exceed 5 fractions), prostate spacer placement requires specific criteria (e.g., no gross posterior extraprostatic extension), and biology‑guided radiotherapy (BgRT, including RefleXion RMRS) is not considered medically necessary/not covered in this excerpt.

"No specific covered indications are listed in this document chunk."