Medical Policy Updates

Table Of Contents

Notification of Policy Revisions Effective July 30, 2013 (Posted April 30, 2013)

Medical Policy Revision
Charged Particle Radiotherapy (Proton or Helium Ion) "Notification" Revised Policy Guidelines section. Under When Covered; added medically necessary indication for pediatric CNS tumors. Under When Not Covered section: added investigational statements for pediatric non-CNS tumors and for tumors of the head and neck, other than skull based chordoma or chondrosarcoma. Added HCPCS code S8030 to the Billing/Coding section. Reference added. Medical director review 3/2013. Notification given 4/30/13 for effective date 7/30/13.
Radioembolization for Primary and Metastatic Tumors of the Liver "Notification" Policy Guidelines and Description sections revised. Under When Not Covered section added investigational indication "Radioembolization is considered investigational to treat primary intrahepatic cholangiocarcinoma." Reference added. Medical director review 3/2013. Notification given 4/30/13 for effective date 7/30/13.