Proton Beam Radiation Therapy – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers proton beam therapy (PBT) without further review for patients under 19 and for specified proven adult indications (e.g., base-of-skull tumors such as chordoma/chondrosarcoma, intracranial AVMs, ocular tumors including uveal melanoma, and localized unresectable HCC in the curative setting), considers PBT clinically equivalent to IMRT for prostate cancer (coverage per member plan), and deems all other indications unproven/not medically necessary except in selected cases. Key requirements: coverage for HCC and any nonlisted/exception indications requires documentation that normal-tissue sparing cannot be achieved with standard techniques (IMRT, SBRT, selective internal radiation spheres and transarterial therapy when applicable) and a patient-specific comparison of PBT, IMRT, and SBRT treatment plans, with final coverage determined by the member-specific benefit plan and applicable laws.

"PBT covered for diagnoses listed in the policy as proven (full list of proven diagnoses not included in this excerpt)."