tci Part B Insider - 2003 Issue 7

COVERAGE: New Radiation Reimbursement Restrictions Could Burn You

Cahaba GBA announced a policy on coverage of intensely moderated radiation therapy (IMRT), a new technology that uses computers to direct specific beams of radiation at a solid tumor inside a patient. The Georgia carrier said it will pay for IMRT if: there are "important dose limiting structures" close to the planned treatment volume but outside of it, and these structures require IMRTto assure safety and morbidity reduction; clinicians have already irradiated a volume immediately adjacent to the treatment area, and they need to establish "abutting portals" with high precision. the gross tumor volume has margins that are concave...

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