Proton Beam Radiotherapy

Proton beam radiotherapy is covered for select indications where its dosimetric advantages reduce normal tissue exposure or improve tumor control, including skull/axial skeleton tumors not amenable to IMRT/3D, pediatric solid tumors (age ≤18), CNS tumors, and intraocular melanoma. Coverage for a broader set of adult malignancies (Group #2) is allowed only when specific clinical dose/precision criteria are met, treatment intent and expected benefit (>2 years for metastatic disease) are documented, and dosimetric evidence and medical-record justification demonstrate proton therapy is the treatment of choice; widely disseminated disease, hematogenous metastases, and short-term palliative use are excluded.

"Proton beam radiotherapy is covered for benign or malignant conditions involving the base of the skull or axial skeleton that are not suitable for IMRT or 3-dimensional conformal therapy, including..."