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Proton Beam Radiation Therapy – Commercial Medical Policy

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UnitedHealthcare® Commercial Medical Policy Proton Beam Radiation Therapy Policy Number: 2021T0132CC Effective Date: May 1, 2021 Instructions for Use Table of Contents Page Related Commercial Policy Coverage Rationale ........................................................................... 1 • Intensity-Modulated Radiation Therapy Documentation Requirements......................................................... 2 • Radiation Therapy: Fractionation, Image-Guidance, Definitions ........................................................................................... 2 and Special Services Applicable Codes .............................................................................. 2 • Stereotactic Body Radiation Therapy and Description of Services ..................................................................... 4 Stereotactic Radiosurgery Clinical Evidence ............................................................................... 4 U.S. Food and Drug Administration ..............................................18 Community Plan Policy References .......................................................................................18 • Proton Beam Radiation Therapy Policy History/Revision Information..............................................23 Medicare Advantage Coverage Summary Instructions for Use .........................................................................23 • Radiologic Therapeutic Procedures Coverage Rationale Note: This policy applies to persons 19 years of age and older. Proton beam radiation therapy (PBRT, PBT) is covered without further review for persons younger than 19 years of age. The following are proven and medically necessary: • PBT for Definitive Therapy of the following indications: o Hepatocellular carcinoma (HCC) (localized, unresectable) in the curative setting when documentation is provided that sparing of the surrounding normal tissue cannot be achieved with standard radiation therapy techniques, including intensity-modulated radiation therapy (IMRT), and stereotactic body radiation therapy (SBRT), and selective internal radiation spheres, and transarterial therapy (for example, chemoembolization) is contraindicated or not technically feasible o Intracranial arteriovenous malformations (AVMs) o Ocular tumors, including intraocular/uveal melanoma (includes the iris, ciliary body and choroid) o Skull-based tumors (e.g., chordomas, chondrosarcomas, paranasal sinus or nasopharyngeal tumors) • PBT may be covered for a diagnosis that is not listed above as proven, including recurrences or metastases in selected cases. Requests for exceptions will be evaluated on a case-by-case basis when both of the following criteria are met: o Documentation is provided that sparing of the surrounding normal tissue cannot be achieved with standard radiation therapy techniques; and o Evaluation includes a comparison of treatment plans for PBT, IMRT and SBRT PBT and IMRT are proven and considered clinically equivalent for treating prostate cancer. Medical necessity will be determined based on the terms of the member’s benefit plan. PBT is unproven and not medically necessary due to insufficient evidence of efficacy for treating all other indications not listed above as proven, including but not limited to: • Age related macular degeneration (AMD) • Bladder cancer Proton Beam Radiation Therapy Page 1 of 23 UnitedHealthcare Commercial Medical Policy Effective 05/01/2021 Proprietary Information of UnitedHealthcare. Copyright 2021 United HealthCare Services, Inc. • Brain and spinal cord tumors • Breast cancer • Choroidal hemangioma • Esophageal cancer • Gynecologic cancers • Head and neck tumors not noted above as proven • Lung cancer • Lymphomas • Pancreatic cancer • Vestibular tumors (e.g., acoustic neuroma or vestibular schwannoma) • PBT used in conjunction with IMRT Documentation Requirements Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The documentation requirements outlined below are used to assess whether the member meets the clinical criteria for coverage but do not guarantee coverage of the service requested. CPT/HCPCS Required Clinical Information Codes* Proton Beam Radiation Therapy (PBT) 77385, 77386, Medical notes documenting all of the following: 77387, 77520, • History of medical condition requiring treatment 77522, 77523, • Documentation that sparing of the surrounding normal tissue cannot be achieved with standard 77525, G6015, radiation therapy techniques G6016 • Evaluation includes a comparison of treatment plans for PBT, IMRT, and stereotactic body radiation therapy (SBRT) • For hypofractionated radiation, provide the prescribed total dose and dose per fraction • For delivery of radiation therapy course with standard fractionation, provide the dose prescription along with documentation in the form of a clearly labeled, color comparative proton, and IMRT dose volume histogram and dose table, in absolute doses noting that sparing of the surrounding normal tissue cannot be achieved with IMRT techniques Note: If citing an RTOG dose constraint, provide the RTOG protocol number • Physician’s treatment plan Note: The color comparative proton and IMRT dose volume histogram and dose table images can be submitted via the external portal at http://www.uhcprovider.com/paan; faxes of images will not be accepted. *For code descriptions, see the Applicable Codes section. Definitions Definitive Therapy: Definitive Therapy is treatment with curative intent. Treatment of a local recurrence of the primary tumor may be considered “Definitive” if there has been a long disease free interval (generally ≥ 2 years) and treatment is with curative intent. Applicable Codes The following list(s) of procedure and/or diagnosis codes is provided for reference purposes only and may not be all inclusive. Listing of a code in this policy does not imply that the service described by the code is a covered or non-covered health service. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The inclusion of a code does not imply any right to reimbursement or guarantee claim payment. Other Policies and Guidelines may apply. Proton Beam Radiation Therapy Page 2 of 23 UnitedHealthcare Commercial Medical Policy Effective 05/01/2021 Proprietary Information of UnitedHealthcare. Copyright 2021 United HealthCare Services, Inc. CPT Code Description 77301 Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications 77338 Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per IMRT plan 77385 Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; simple 77386 Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex 77387 Guidance for localization of target volume for delivery of radiation treatment, includes intrafraction tracking, when performed 77520 Proton treatment delivery; simple, without compensation 77522 Proton treatment delivery; simple, with compensation 77523 Proton treatment delivery; intermediate 77525 Proton treatment delivery; complex CPT® is a registered trademark of the American Medical Association HCPCS Code Description G6015 Intensity modulated treatment delivery, single or multiple fields/arcs, via narrow spatially and temporally modulated beams, binary, dynamic MLC, per treatment session G6016 Compensator-based beam modulation treatment delivery of inverse planned treatment using 3 or more high resolution (milled or cast) compensator, convergent beam modulated fields, per treatment session G6017 Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (e.g., 3D positional tracking, gating, 3D surface tracking), each fraction of treatment Diagnosis Code Description C11.0 Malignant neoplasm of superior wall of nasopharynx C11.1 Malignant neoplasm of posterior wall of nasopharynx C11.2 Malignant neoplasm of lateral wall of nasopharynx C11.3 Malignant neoplasm of anterior wall of nasopharynx C11.8 Malignant neoplasm of overlapping sites of nasopharynx C11.9 Malignant neoplasm of nasopharynx, unspecified C22.0 Liver cell carcinoma C30.0 Malignant neoplasm of nasal cavity C31.0 Malignant neoplasm of maxillary sinus C31.1 Malignant neoplasm of ethmoidal sinus C31.2 Malignant neoplasm of frontal sinus C31.3 Malignant neoplasm of sphenoid sinus C31.8 Malignant neoplasm of overlapping sites of accessory sinuses C31.9 Malignant neoplasm of accessory sinus, unspecified C41.0 Malignant neoplasm of bones of skull and face C61.0 Malignant neoplasm of prostate C69.30 Malignant neoplasm of unspecified choroid C69.31 Malignant neoplasm of right choroid C69.32 Malignant neoplasm of left choroid C69.40 Malignant neoplasm of unspecified ciliary body Proton Beam Radiation Therapy Page 3 of 23 UnitedHealthcare Commercial Medical Policy Effective 05/01/2021 Proprietary Information of UnitedHealthcare. Copyright 2021 United HealthCare Services, Inc. Diagnosis Code Description C69.41 Malignant neoplasm of right ciliary body C69.42 Malignant neoplasm of left ciliary body D09.20 Carcinoma in situ of unspecified eye D09.21 Carcinoma in situ of right eye D09.22 Carcinoma in situ of left eye D14.0 Benign neoplasm
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