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Evicore Radiation Oncology Guidelines

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Evicore Radiation Oncology Guidelines CLINICAL GUIDELINES Radiation Oncology Version 2.0 Effective October 1, 2021 Clinical guidelines for medical necessity review of radiation therapy services. © 2021 eviCore healthcare. All rights reserved. Radiation Oncology Guidelines V2.0 Please note the following: CPT Copyright 2021 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. ______________________________________________________________________________________________________ © 2021 eviCore healthcare. All Rights Reserved. Page 2 of 296 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www.eviCore.com Radiation Oncology Guidelines V2.0 Please note the following: All information provided by the NCCN is “Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines™)©2018/2019/2020/2021 National Comprehensive Cancer Network. The NCCN Guidelines™ and illustrations herein may not be reproduced in any form for any purpose without the express written permission of the NCCN. To view the most recent and complete version of the NCCN Guidelines, go online to NCCN.org.” ______________________________________________________________________________________________________ © 2021 eviCore healthcare. All Rights Reserved. Page 3 of 296 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www.eviCore.com Radiation Oncology Guidelines V2.0 Table of Contents Preface to the Radiation Oncology Guidelines 6 Abbreviations for Radiation Oncology Guidelines 8 Radiation Oncology Guidelines For Special Techniques 10 Brachytherapy of the Coronary Arteries 11 Hyperthermia 20 Image-Guided Radiation Therapy (IGRT) 23 Neutron Beam Therapy 27 Proton Beam Therapy 29 Radiation Oncology Guidelines For Treatment by Site 73 Adrenocortical Carcinoma 74 Anal Canal Cancer 77 Bladder Cancer 80 Bone Metastases 84 Brain Metastases 89 Breast Cancer 97 Cervical Cancer 112 Endometrial Cancer 120 Esophageal Cancer 125 Gastric Cancer 129 Head and Neck Cancer 132 Hepatobiliary Cancer 136 Hodgkin Lymphoma 142 Kidney Cancer 146 Multiple Myeloma and Solitary Plasmacytomas 149 Non-Hodgkin Lymphoma 152 Non-Malignant Disorders 158 Non-Small Cell Lung Cancer 178 Oligometastases 189 Other Cancers 199 Pancreatic Cancer 200 Primary Craniospinal Tumors and Neurologic Conditions 206 Prostate Cancer 214 Rectal Cancer 228 ______________________________________________________________________________________________________ © 2021 eviCore healthcare. All Rights Reserved. Page 4 of 296 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www.eviCore.com Radiation Oncology Guidelines V2.0 Skin Cancer – Melanoma 233 Skin Cancer – Non-Melanoma 237 Small Cell Lung Cancer 244 Soft Tissue Sarcomas 247 Testicular Cancer 253 Thymoma and Thymic Cancer 256 Urethral Cancer and Upper Genitourinary Tract Tumors 260 Vulvar Cancer 262 Radiation Oncology Guidelines For Radiopharmaceuticals 268 Azedra® (iobenguane I-131) 269 Lutathera® (lutetium Lu 177 dotatate) 272 Selective Internal Radiation Therapy (SIRT) 276 Xofigo® (Radium-223) 282 Zevalin® 284 eviCore V2.0 (2021) Key Updates: Radiation Oncology Guidelines 296 ______________________________________________________________________________________________________ © 2021 eviCore healthcare. All Rights Reserved. Page 5 of 296 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www.eviCore.com Radiation Oncology Guidelines V2.0 Preface to the Radiation Oncology Guidelines Prior Authorization Requirements eviCore applies an evidence-based approach to evaluate the most appropriate medically necessary regimen for each individual. For requests that fall outside of guidelines, submission of medical records are needed to document an individual’s current clinical status and why an exception to policy is being requested. Without this information, medical necessity for the request cannot be established. Specific elements of an individual’s medical records commonly required to establish medical necessity include, but are not limited to: Recent (within 60 days) virtual or in-person Radiation Oncology consultation which includes a detailed history, physical examination and diagnosis including stage of disease and type of tumor Radiation prescription and treatment plan(s) including the documentation of the technique and number of treatments (fractions) prescribed Imaging studies (i.e. those ordered to stage an individual) Reports from other providers participating in treatment of the relevant condition Out of Scope Treatments Requests for SpaceOARTM, Optune®, MRgFUS (MR-guided focused ultrasound), GliaSite® and HIPEC (Hyperthermic Intraperitoneal Chemotherapy) are not reviewed by eviCore and, as such, these requests should be directed to the health plan. In addition, requests for radiation treatment given to an individual during an inpatient stay (i.e. non-breast IORT) should be directed to the health plan. Similar or Duplicate Requests Requests that are similar or duplicative to a treatment recently approved will require additional individual clinical information to determine medical necessity. Sequential Versus Concurrent Requests When multiple lesions are present in a single episode of care, treatment should be delivered concurrently, rather than sequentially. Medicare Coverage Policies For Medicare and Medicare Advantage enrollees, the coverage policies of CMS (Centers for Medicare and Medicaid Services) supersede eviCore’s guidelines. Experimental, Investigational, and/or Unproven (EIU) Studies Certain treatments may be considered experimental, investigational, and/or unproven (if there is a paucity of supporting evidence, if the evidence has not matured to exhibit improved health parameters, or the treatment lacks a collective opinion of support). ______________________________________________________________________________________________________ © 2021 eviCore healthcare. All Rights Reserved. Page 6 of 296 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www.eviCore.com Radiation Oncology Guidelines V2.0 Clinical and Research Trials Similar to experimental, investigational, and/or unproven studies, clinical trial requests will be considered to determine whether they meet health plan coverage and eviCore’s evidence-based guidelines. Legislative Mandate State and federal legislations may need to be considered in the review of radiation oncology requests. Reference 1. https://www.cms.gov/Medicare/Medicare-Fee-for-Service- Payment/AcuteInpatientPPS/Downloads/FY_14_Definition_of-Medicare_Code_Edits_V_31_Manual.pdf. ______________________________________________________________________________________________________ © 2021 eviCore healthcare. All Rights Reserved. Page 7 of 296 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www.eviCore.com Radiation Oncology Guidelines V2.0 Abbreviations for Radiation Oncology Guidelines 3D Three-dimensional Three-dimensional conformal radiation 3DCRT ACR American College of Radiology therapy ADT Androgen deprivation therapy AJCC American Joint Committee on Cancer AML Acute myeloid leukemia APBI Accelerated partial breast irradiation AP-PA Anteroposterior-posteroanterior ASTRO American Society for Radiation Oncology Brachy Brachytherapy BUN Blood urea nitrogen CALGB Cancer and Leukemia Group B CBC Complete blood count CNS Central nervous system CRA Cardiac radioablation CT Computed tomography DIBH Deep inspiration breath hold External beam radiation DLBCL Diffuse large B cell lymphoma EBRT therapy ECOG Eastern Cooperative Oncology Group European Organisation for Research Experimental, investigational, EORTC EIU and Treatment of Cancer and/or unproven FDA Food and Drug Administration International Federation of Gynecology FIGO GOG Gynecologic Oncology Group and Obstetrics GS Gleason score HA- Hippocampal-avoidance whole Gy Gray WBRT brain radiation therapy HDR High-dose rate International Lymphoma IGRT Image-guided radiation therapy ILROG Radiation Oncology Group IMRT Intensity-modulated radiation therapy IORT Intraoperative radiation therapy IRF Intermediate risk factor KPS Karnofsky performance status LDH Lactate dehydrogenase LDR Low-dose rate MDS Myelodysplastic syndrome National Comprehensive MRI Magnetic resonance imaging NCCN® Cancer Network Radiation Oncology ______________________________________________________________________________________________________ © 2021 eviCore healthcare. All Rights Reserved. Page 8 of 296 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www.eviCore.com Radiation Oncology Guidelines V2.0 NK Natural killer National Surgical Adjuvant Breast and NSABP NSCLC Non-small cell lung cancer Bowel Project OS Overall survival PBT Proton beam therapy PCI Prophylactic cranial irradiation PET Positron emission tomography PFS Progression free survival PSA Prostate specific antigen PTV Planning target volume RECIST Response Evaluation Criteria in Solid Tumors RTOG Radiation Therapy Oncology Group SBRT Stereotactic body radiation therapy SCLC Small cell lung cancer Surveillance, Epidemiology, and End SEER SRS Stereotactic radiosurgery Results Program SWOG Southwest Oncology Group TBI Total body irradiation VMAT Volumetric modulated arc therapy WBRT Whole brain radiation therapy WHO World Health Organization Radiation Oncology ______________________________________________________________________________________________________ © 2021 eviCore healthcare. All Rights Reserved. Page 9 of 296 400 Buckwalter Place Boulevard, Bluffton,
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