Effective for claims with dates of service beginning July 1, 2013, Harvard Pilgrim is expanding coverage of stereotactic radiosurgery to include spinal and lung tumors. Under the new policy, stereotactic body radiation therapy will be covered when it is considered medically necessary in the treatment of:
- Primary or recurrent tumors within the spine, or metastases to the spine from other primary sites that are both not amenable to surgery and not amenable to conventional radiation therapy
- Early stage (T1 or T2) non small-cell lung cancer (NSCLC) in an individual who is not a surgical candidate or refuses surgery
- Symptomatic pulmonary metastasis in an individual with good performance status and controlled systemic disease
These changes were made based on a review of current medical literature. For complete information, including a listing of newly added codes, please see the updated Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy Clinical Medical Policy.