Intensity-Modulated Radiation Therapy – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers IMRT for adults (≥19) for a specified list of primary cancer sites and scenarios (including anus, selected breast cases, CNS tumors, cervical, endometrial, esophageal, specified head & neck sites, mediastinal tumors, stage III NSCLC with chemoradiation, pancreatic, prostate, and vulvar cancers), allows compensator-based modulation when combined with a covered IMRT indication, and permits hippocampal‑avoidance WBRT (≤10 fractions) when strict performance‑status, prognosis (≥4 months) and absence of leptomeningeal disease criteria are met, while IMRT combined with proton therapy is considered unproven and not medically necessary. Exceptions for non‑listed indications or reirradiation are reviewed case‑by‑case and require supporting documentation (e.g., IMRT vs non‑IMRT plan comparisons, prior radiation dose records) and adherence to technical/verification expectations (e.g., image‑guided/daily setup verification for SIB, prostate parameters such as ≥6 MV and typical 5–9 field plans, pelvic node doses 45–52 Gy where applicable).