Radiation Therapies

Covered: SRS/SBRT and IMRT are allowed for many guideline‑supported primary and metastatic indications (e.g., renal, adrenal, pancreatic tumors, liver metastases including breast, spinal lesions, pituitary adenomas, acoustic neuromas, intracranial AVMs, selected brain metastases including some SCLC cases, low‑ to intermediate‑risk prostate without pelvic nodal irradiation, oligometastatic lung, early‑stage NSCLC, uveal melanoma, unresectable HCC/cholangiocarcinoma and other cancers cited by NCCN/ASTRO/ACR); SBRT is not covered for patients with poor performance status (KPS <40 or ECOG ≥3), when the tumor cannot be safely encompassed or pelvic nodal irradiation is required for prostate, as a boost after conventional RT, for courses >5 fractions, or for primary lesions/organs not listed as covered. Key requirements: treatment must be delivered by appropriately trained/credentialed providers and facilities meeting federal/state/NRC rules with complete, authenticated documentation of medical necessity, intent, performance status, prescription, target/CTV/PTV and OAR constraints, independent dose calculations/verification, treatment planning details and required signatures (including medical physicist and radiation oncologist) and adherence to SRS/SBRT supervision and fractionation rules.