Superficial Radiation Therapy (SRT) for the Treatment of Nonmelanoma Skin Cancers (NMSC)
L40167
SRT is covered for low-risk or high-risk BCC and SCC (including SCC in situ) when the patient is documented as a nonsurgical candidate and risk stratification per NCCN/ASTRO/AAD supports use. SRT and EBT are excluded in multiple scenarios including first-line use in surgical candidates, tumors >4 cm, depth >6 mm, aggressive morphology, perineural/perivascular invasion as sole therapy, very-high-risk SCC, previously irradiated/overlapping fields, and EBT or HRUS-guided SRT due to insufficient evidence. Coverage requires medical-record documentation of medical necessity, guideline-based risk stratification, justification of nonsurgical candidacy (or documented refusal after shared decision making), appropriate depth measurement, and performance by qualified providers in compliant facilities.
"SRT is reasonable and necessary for treatment of low-risk or high-risk cutaneous basal cell carcinoma (BCC) per NCCN/ASTRO/AAD guidelines when the patient is documented to be a nonsurgical candidate."