Intensity-Modulated Radiation Therapy - UHCprovider.com

Intensity-Modulated Radiation Therapy Page 1 of 21 UnitedHealthcare Commercial Medical Policy Effective 03/01/2022 Proprietary Information of UnitedHealthcare. Copyright 2022 United HealthCare Services, Inc. UnitedHealthcare Commercial Medica l Policy Intensity-Modulated Radiation Therapy Policy Number: 2022T0407Y Effective Date: March 1, 2022 Instructions for Use Table of Contents Page Coverage Rationale .. 1 Documentation Requirements .. 2 Definitions .. 3 Applicable Codes .. 3 Description of Services .. 3 Benefit Considerations .. 4 Clinical 4 Food and Drug 17 References .. 17 Policy History/Revision Information .. 20 Instructions for 20 Coverage Rationale See Benefit Considerations Note: This policy applies to persons 19 years of age and older. Intensity-Modulated Radiation Therapy (IMRT) is covered without further review for persons 18 years and younger. The following are proven and medically necessary: IMRT for Definitive Therapy of the primary site of the following conditions: o Anal cancer o Breast cancer in the following circumstances: When the left-sided internal mammary nodes are being treated; or Partial breast irradiation of up to 5 fractions o Central nervous system (CNS) tumors (primary or benign) including the brain, brainstem and spinal cord o Cervical cancer o Endometrial cancer o Esophageal cancer o Head and neck cancers, incl

Intensity-modulated radiation therapy (IMRT) is an advanced mode of high -precsii on RT that uses computer -controlel d linear accelerators to deliver precise radiation doses to a malignant tumor or specific areas within the tumor.

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  Therapy, Intensity, Radiation, Modulated, Intensity modulated radiation therapy

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