Intraoperative Radiation Therapy

This LCD covers intraoperative radiation therapy (IORT) defined as therapeutic radiation initiated after surgical exposure and completed before the patient leaves the operating room, when used as part of reasonable and necessary surgical cancer care. Coverage is limited to specific clinical scenarios including select breast (APBI-appropriate) patients meeting NCCN-based criteria, colon/rectal cancers with T4, recurrent disease, or positive/close margins, soft tissue sarcomas at high risk for incomplete resection, and certain uterine/cervical cancer situations; IORT is considered not reasonable and necessary for gastric/gastroesophageal, pancreatic, esophageal, lung, and brain cancers, as well as when surgery is performed solely to deliver radiation or when a complete/radical mastectomy is performed. Documentation requirements include detailed pre-procedure evaluation, multidisciplinary treatment planning, and a procedure note specifying mode, anatomic site(s), and dose in Gray, and provider qualifications.