tci Medicare Compliance & Reimbursement - 2004 Issue 30

Oncology: Carriers Set Limits On New Breast Cancer Technique

APBI policies follow physician society's recommendation.A new technology is revolutionizing breast cancer treatment - but for now, carriers are lining up to put severe limits on it. Draft local coverage determinations from National Heritage Insurance Co. and Arkansas Medicare are putting sharp limits on coverage for accelerated partial breast irradiation, a new technique.  Unlike whole-breast external-beam radiation therapy, ABPI targets only a segment of the breast after a lumpectomy. Also, radiation is delivered over four to five days instead of over five to six weeks, at higher doses per session. APBI includes brachytherapy via catheter, the...

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