Notification

Proton Beam Radiation Therapy


Notification Issue Date: 05/31/2019

This version of the policy will become effective 07/01/2019.

Language was revised under the Not Medically Necessary heading.

The following indications were added as Medically Necessary:

  • Intrahepatic Cholangiocarcinoma
  • Malignancies requiring Craniospinal Irradiation (CSI)
  • Pediatric Malignancies

The following indications were added as Not Medically Necessary:
  • Locally advanced Breast Cancer when treating the internal mammary nodes
  • Primary CNS cancer
  • Remaining cases of unresectable hepatocellular carcinoma and intrahepatic cholangiocarcinoma
  • Hodgkin’s Lymphoma
  • Non-Hodgkin's Lymphoma
  • Stage IIIB Non-Small Cell Lung Cancer
  • Pancreatic cancer
  • Retroperitoneal Sarcoma
  • Thymomas and Thymic Carcinoma

The following indications were revised under Not Medically Necessary:
  • Head and neck cancer (not including the brain)
  • Prostate cancer

The following indications were removed from Experimental/Investigational:
  • When delivered in an ablative manner (i.e., Stereotactic Body Radiation Therapy (SBRT))
  • In combination with photon therapy for any tumor
  • For the treatment of laryngeal cancer [stage T1 or T2, cancer has not spread to lymph nodes (N0), and the disease has not metastasized (M0)]

The following indication was revised under Experimental/Investigational:
  • Prostate cancer after prostatectomy

Language addressing code S8030 was removed from the policy.

Coding

Attachment A was created, and all ICD-10 Diagnosis Codes were moved into the Attachment.

The following ICD-10 Diagnosis Codes were added as Medically Necessary:

C63.7, C63.8

The following ICD-10 Diagnosis Codes were added as Not Medically Necessary:

C25.0, C25.1, C25.2, C25.3, C25.4, C25.7, C25.8, C25.9, C34.00, C34.01, C34.02, C34.10, C34.11, C34.12, C34.2, C34.30, C34.31, C34.32, C34.80, C34.81, C34.82, C34.90, C34.91, C34.92, C48.0, C48.8, C50.011, C50.012, C50.019, C50.021, C50.022, C50.029, C50.111, C50.112, C50.119, C50.121, C50.122, C50.129, C50.211, C50.212, C50.219, C50.221, C50.222, C50.229, C50.311, C50.312, C50.319, C50.321, C50.322, C50.329, C50.411, C50.412, C50.419, C50.421, C50.422, C50.429, C50.511, C50.512, C50.519, C50.521, C50.522, C50.529, C50.611, C50.612, C50.619, C50.621, C50.622, C50.629, C50.811, C50.812, C50.819, C50.911, C50.912, C50.919, C71.0, C71.1, C71.2, C71.3, C71.4, C71.5, C71.6, C71.7, C71.8, C71.9, C81.00, C81.01, C81.02, C81.03, C81.04, C81.05, C81.06, C81.07, C81.08, C81.09, C81.10, C81.11, C81.12, C81.13, C81.14, C81.15, C81.16, C81.17, C81.18, C81.19, C81.20, C81.21, C81.22, C81.23, C81.24, C81.25, C81.26, C81.27, C81.28, C81.29, C81.30, C81.31, C81.32, C81.33, C81.34, C81.35, C81.36, C81.37, C81.38, C81.39, C81.40, C81.41, C81.42, C81.43, C81.44, C81.45, C81.46, C81.47, C81.48, C81.49, C81.70, C81.71, C81.72, C81.73, C81.74, C81.75, C81.76, C81.77, C81.78, C81.79, C85.10, C85.11, C85.12, C85.13, C85.14, C85.15, C85.16, C85.17, C85.18, C85.19, C85.20, C85.21, C85.22, C85.23, C85.24, C85.25, C85.26, C85.27, C85.28, C85.29, C85.80, C85.81, C85.82, C85.83, C85.84, C85.85, C85.86, C85.87, C85.88, C85.89, C81.90, C81.91, C81.92, C81.93, C81.94, C81.95, C81.96, C81.97, C81.98, C81.99, C85.90, C85.91, C85.92, C85.93, C85.94, C85.94, C85.95, C85.96, C85.97, C85.98, C85.99

The following HCPCS Code was removed from the policy: S8030


Medical Policy Bulletin


Title:Proton Beam Radiation Therapy

Policy #:09.00.49l

This policy is applicable to the Company’s commercial products only. Policies that are applicable to the Company’s Medicare Advantage products are accessible via a separate Medicare Advantage policy database.


The Company makes decisions on coverage based on Policy Bulletins, benefit plan documents, and the member’s medical history and condition. Benefits may vary based on contract, and individual member benefits must be verified. The Company determines medical necessity only if the benefit exists and no contract exclusions are applicable.

When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.

This Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.



Policy

Coverage is subject to the terms, conditions, and limitations of the member's contract. The Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition.


This policy only applies to members for whom Independence Administrators serves as the claims administrator, as well as those self-funded groups for whom eviCore's Radiation Therapy Services program is not applicable. For all other Independence members, refer to the policy entitled Radiation Therapy Services.


MEDICALLY NECESSARY

Proton beam radiation therapy is considered medically necessary and, therefore, covered for the curative treatment of any of the following:
  • Chordomas and chondrosarcomas of the base of the skull, localized and in the postoperative setting
  • Uveal melanoma, when proton beam radiation therapy is considered preferential compared to brachytherapy
  • Localized unresectable hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma
  • Stage IIA seminoma
  • Malignancies requiring Craniospinal Irradiation (CSI)

Proton beam radiation therapy is considered medically necessary and, therefore, covered for the treatment of pediatric malignancies.

NOT MEDICALLY NECESSARY

For the following indications, the available evidence currently does not support a definitive benefit of proton beam radiation therapy over photons. As such, proton beam radiation therapy for the curative treatment of the following cancers is considered not medically necessary and, therefore, not covered:
  • Locally advanced breast cancer when treating the internal mammary nodes
  • Primary CNS cancer
  • Esophageal cancer
  • Head and neck cancer (excluding T1-T2N0M0 laryngeal cancer, i.e., stage T1 or T2, cancer has not spread to lymph nodes (N0), and the disease has not metastasized (M0))
  • Remaining cases of unresectable hepatocellular carcinoma and intrahepatic cholangiocarcinoma
  • Hodgkin’s lymphoma
  • Non-Hodgkin's lymphoma
  • Stage IIIB non-small cell lung cancer
  • Pancreatic cancer
  • Prostate cancer (Unoperated)
  • Retroperitoneal sarcoma
  • Thymomas and thymic carcinoma

EXPERIMENTAL/INVESTIGATIONAL

Proton beam radiation therapy is considered experimental/investigational and, therefore, not covered for all other indications including the following because the safety and/or effectiveness of this service cannot be established by review of the available published peer-reviewed literature:
  • Adjuvant or salvage treatment of prostate cancer (i.e., after prostatectomy)

REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the health care professional's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.
Guidelines

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, proton beam radiation therapy is covered under the medical benefits of the Company’s products when the medical necessity criteria listed in this medical policy are met.

Services that are experimental/investigational are a benefit contract exclusion for all products of the Company. Therefore, they are not eligible for reimbursement consideration.

US FOOD AND DRUG ADMINISTRATION (FDA) STATUS

There are several proton beam therapy systems approved by the FDA for administering proton beam radiation.

Description

Proton beam radiation therapy is a type of radiation therapy that utilizes protons to deliver ionizing damage to a target. Protons are positively charged, subatomic particles that deposit the bulk of their radiation energy at the end of their range of penetration (e.g., into the tumor). This peak of energy deposition is referred to as the Bragg peak. Proton beam radiation therapy allows for targeted dosing of proton radiation to a particular tumor site, with minimal dose delivery to surrounding normal tissue, theoretically offering an advantage over the delivery of photons (i.e., gamma-rays, X-rays, conventional electromagnetic radiation therapy), which deposit their energy along a more disseminated distribution.

This dose-targeting advantage of proton beam radiation therapy may be an improvement over conventional radiation therapy because conventional treatment modalities do not provide adequate local tumor control. Local tumor response depends on the dose of radiation delivered, and delivery of an adequate radiation dose to the tumor is limited by the proximity of vital radiosensitive tissues or structures. However, advances in photon-based radiation therapy, such as 3-D conformal radiation therapy, intensity-modulated radiation therapy, and stereotactic body radiotherapy, do allow for improved targeting of conventional radiation therapy.

Proton beam radiation therapy can best treat tumors that are localized and have not spread to distant areas of the body, tumors that are not amenable to surgical excision or other conventional forms of radiation treatment (e.g., tumors in close proximity to vital organs and structures), and tumors that are difficult or dangerous to treat with surgery (e.g., tumors of the eye, head, neck). Proton beam radiation therapy is being used to treat pediatric tumors in or near the brain and when it is necessary to lessen the risk for secondary tumors due to the individual's potentially long lifespan after radiation treatment, which involves risk for radiation-induced malignancies.

Proton beam radiation therapy has been used in the treatment of two general categories of tumors or abnormalities. The first category includes tumors located near vital organs, such as intracranial lesions or those along the axial skeleton, e.g., uveal melanoma, brain tumors, chordomas, and other chondrosarcomas at the base of the skull and along the axial skeleton. The second category currently under investigation involves tumors with a high rate of recurrence despite maximal doses of conventional radiation therapy, e.g., stages C or D1 of locally advanced prostate cancer (without metastases; and not stage T4).

Current evidence supports the use of proton beam radiation therapy in the treatment of chordomas and chondrosarcomas of the base of the skull, uveal melanoma, localized unresectable hepatocellular carcinoma (HCC), and stage IIA seminoma.

For previously untreated prostate cancer, head and neck cancer, and preoperative and definitive treatment of esophageal cancer, current evidence indicates that proton beam radiation therapy is no more effective than other forms of radiation therapy (e.g., IMRT).

For all other conditions, further research is needed on proton beam radiation therapy to establish its safety and effectiveness.
References


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Agency for Healthcare Research and Quality (AHRQ). Particle beam radiation therapies for cancer. September 2009. Available at: https://www.effectivehealthcare.ahrq.gov/topics/cancer-radiation/technical-brief. Accessed March 13, 2019.

Al-Mefty O, Borba LAB. Skull base chordomas a management challenge. J Neurosurg. 1997;86(2):182-9.

Allen AM, Pawlicki T, Dong L, et al. An evidence based review of proton beam therapy: the report of ASTRO's emerging technology committee. Radiother Oncol. 2012;103(1):8-11.

American Society for Radiation Oncology (ASTRO). Model Policy: Proton Beam Therapy (PBT). June 2017. Available at: https://www.astro.org/uploadedFiles/_MAIN_SITE/Daily_Practice/Reimbursement/Model_Policies/Content_Pieces/ASTROPBTModelPolicy.pdf. Accessed March 13, 2019.

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Bechrakis NE, Foerster MH. Neoadjuvant proton beam radiotherapy combined with subsequent endoresection of choroidal melanomas. Int Ophthalmol Clin. 2006;46(1):95-107.

Bekelman JE, Schultheiss T, Berrington De Gonzalez A. Subsequent malignancies after photon versus proton radiation therapy. Int J Radiat Oncol Biol Phys. 2013; 87(1):10-12.

Benk VA, Adams JA, Shipley WU, et al. Late rectal bleeding following combined X-ray and proton high dose irradiation for patients with stages T3-T4 prostate cancer. Int J Radiat Oncol Biol Phys. 1993;26(3):551-7.

Berrington de Gonzalez A, Gilbert E, Curtis R, et al. Second solid cancers after radiation therapy: a systematic review of the epidemiologic studies of the radiation dose-response relationship. Int J Radiat Oncol Biol Phys. 2013; 86(2):224-233.

Bhattasali O, Holliday E, Kies MS, et al. Definitive proton radiation therapy and concurrent cisplatin for unresectable head and neck adenoid cystic carcinoma: a series of 9 cases and a critical review of the literature. Head Neck. 2016;38(S1):E1472-E1480.

Bishop AJ, Greenfield B, Mahajan A, et al. Proton beam therapy versus conformal photon radiation therapy for childhood craniopharyngioma: multi-institutional analysis of outcomes, cyst dynamics, and toxicity. Int J Radiat Oncol Biol Phys. 2014;90(2):354-361.

Blanchard P, Garden AS, Gunn GB, et al. Intensity-modulated proton beam therapy (IMPT) versus intensitymodulated photon therapy (IMRT) for patients with oropharynx cancer – a case matched analysis. Radiother Oncol. 2016;120(1):48-55.

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Bouchard M, Amos RA, Briere TM, et al. Dose escalation with proton or photon radiation treatment for pancreatic cancer. Radiother Oncol. 2009;92(2):238-243.

Brada M, Pijls-Johannesma M, De Ruysscher D. Current clinical evidence for proton therapy. Cancer J. 2009;15(4):319-24.

Bradley JA, Dagan R, Ho, MW, et al. Initial report of a prospective dosimetric and clinical feasibility trial demonstrates the potential of protons to increase the therapeutic ratio in breast cancer compared with photons. Int J Radiat Oncol Biol Phys. 2016 May;95(1):411-421.

Brenner DJ, Hall EJ. Secondary neutrons in clinical proton radiotherapy: a charged issue. Radiother Oncol. 2008; 86(2):165-70.

Bush DA, Cheek G, Zaheer S, et al. High-dose hypofractionated proton beam radiation therapy is safe and effective for central and peripheral early-stage non-small cell lung cancer: results of a 12-year experience at Loma Linda University Medical Center. Int J Radiat Oncol Biol Phys. 2013;86(5):964-968.

Bush DA, McAllister CJ, Loredo LN, et al. Fractionated proton beam radiotherapy for acoustic neuroma. Neurosurgery. 2002;50(2):270-3.

Cella L, Conson M, Pressello MC, et al. Hodgkin’s lymphoma emerging radiation treatment techniques: trade-offs between late-night radio-induced toxicities and secondary malignant neoplasms. Radiat Oncol. 2013;8:22.

Chan AW, Liebsch NJ. Proton radiation therapy for head and neck cancer. J Surg Oncol. 2008; 97(8):697700.

Chang JY, Jabbour SK, De Ruysscher D, et al. Consensus statement on proton therapy in early-stage and locally advanced non-small cell lung cancer. Int J Radiat Oncol Biol Phys. 2016;95(1):505-516.

Chang JY, Komaki R, Lu C, et al. Phase 2 study of high-dose proton therapy with concurrent chemotherapy for unresectable stage III nonsmall cell lung cancer. Cancer. 2011; 117(20):4707-4713.

Chang JY, Verma V, Li M, et al. Proton beam radiotherapy and concurrent chemotherapy for unresectable Stage III non-small cell lung cancer. JAMA Oncol. 2017;3(8):e172032.

Chang JY, Zhang X, Wang X, et al. Significant reduction of normal tissue dose by proton radiotherapy compared with three-dimensional conformal or intensity-modulated radiation therapy in Stage I or Stage III non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2006;65(4):1087-1096.

Char DH, Kroll S, Phillips TL, et al. Late radiation failures after iodine 125 brachytherapy for uveal melanoma compared with charged-particle (proton or helium ion) therapy. Ophthalmology. 2002; 109(10):1850-1854.

Chera BS, Rodriguez C, Morris CG, et al. Dosimetric comparison of three different involved nodal irradiation techniques for stage II Hodgkin’s lymphoma patients: conventional radiotherapy, intensity-modulated radiotherapy, and three-dimensional proton radiotherapy. Int J Radiat Oncol Biol Phys. 2009;75(4):1173-1180.

Chung CS, Yock TI, Nelson K, et al. Incidence of second malignancies among patients treated with proton versus photon radiation. Int J Radiat Oncol Biol Phys. 2013; 87(1):46-52.

Ciezki JP, Hsu IC, Abdel-Wahab M, et al. American College of Radiology Appropriateness Criteria(®)--locally advanced (high-risk) prostate cancer. Clin Oncol (R Coll Radiol). 2012;24(1):43-51.

Ciulla TA, Danis RP, Klein SB, et al. Proton therapy for exudative age-related macular degeneration: a randomized, sham-controlled clinical trial. Am J Ophthalmol. 2002;134(6):905-906.

Clivio A, Kluge A, Cozzi L, Köhler C, Neumann O, Vanetti E, Wlodarczyk W, Marnitz S Intensity modulated proton beam radiation for brachytherapy in patients with cervical carcinoma. Int J Radiat Oncol Biol Phys. 2013;87(5):897-903.

Coeh JJ, Zietman AL, Rossi CJ, et al. Comparison of high-dose proton radiotherapy and brachytherapy in localized prostate cancer: a case-matched analysis. Int J Radiat Oncol Biol Phys. 2012;82(1):e25-e31.

Coen JJ, Bae K, Zietman AL, et al. Acute and late toxicity after dose escalation to 82 GyE using conformal proton radiation for localized prostate cancer: initial report of American College of Radiology Phase II study 03-12. Int J Radiat Oncol Biol Phys. 2011; 81(4):1005-1009.

Coen JJ, Paly JJ, Niemierko A, et al. Long-term quality of life outcome after proton beam monotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2012;82(2):e201-209.

Colaco RJ, Nichols RC, Huh S, et al. Protons offer reduced bone marrow, small bowel, and urinary bladder exposure for patients receiving neoadjuvant radiotherapy for resectable rectal cancer. J Gastrointest Oncol. 2014;5:3-8.

Conway RM, Poothullil AM, Daftari IK, et al. Estimates of ocular and visual retention following treatment of extralarge uveal melanomas by proton beam radiotherapy. Arch Ophthalmol. 2006; 124(6):838–843.

Cotter SE, McBride SM, Yock TI. Proton radiotherapy for solid tumors of childhood. Technol Cancer Res Treat. 2012;11(3):267-278.

Courdi A, Caujolle JP, Grange JD, et al. Results of proton therapy of uveal melanomas treated in Nice. Int J Radiat Oncol Biol Phys. 1999;45(1):5-11.

Cox JD. Dose escalation by proton irradiation for adenocarcinoma of the prostate. Int J Radiat Oncol Biol Phys. 1995;32(1):265-6.

Cozzi L, Fogliata A, Lomax A. A treatment planning comparison of 3D conformal therapy, photon therapy, and proton therapy for treatment of advanced head and neck tumors. Radiother Oncol. 2001;61(3):287-97.

Cuaron JJ, Chon B, Tsai H, et al. Early toxicity in patients treated with postoperative proton therapy for locally advanced breast cancer. Int J Radiat Oncol Biol Phys. 2015;92(2):284-291.

Damato B, Kacperek A, Chopra M, et al. Proton beam radiotherapy of choroidal melanoma: the Liverpool-Clatterbridge experience. Int J Radiat Oncol Biol Phys. 2005;62(5):1405-11.

Damato B, Kacperek A, Chopra M, et al. Proton beam radiotherapy of iris melanoma. Int J Radiat Oncol Biol Phys. 2005;63(1):109-15.

Damato B, Lecuona K. Conservation of eyes with choroidal melanoma by a multimodality approach to treatment an audit of 1632 patients. Ophthalmology. 2004;111(5):977-83.

De Boer P, van de Schoot AJAJ, Westerveld H, Smit M, Buist MR, Bel A, Rasch CRN, Stalpers LJA. Target tailoring and proton beam therapy to reduce small bowel dose in cervical cancer radiotherapy : A comparison of benefits. Strahlenther Onkol. 2018;194(3):255-263.

De Ruysscher D, Mark Lodge M, Jones B, et al. Charged particles in radiotherapy: a 5-year update of a systematic review. Radiother Oncol. 2012;103(1):5-7.

Debus J, Schulz-Ertner D, Schad L, et al. Stereotactic fractionated radiotherapy for chordomas and chondrosarcomas of the skull base. Int J Radiat Oncol Biol Phys. 2000; 47(3):591-596.

Dědečková K, Móciková H, Marková J, et al. T011: Proton radiotherapy for mediastinal Hodgkin lymphoma: single institution experience (abstract). Haematologica. 2016;101(Suppl 5):12-13.

DeLaney TF, Liebsch NJ, Pedlow FX, et al. Long-term results of Phase II study of high dose photon/proton radiotherapy in the management of spine chordomas, chondrosarcomas, and other sarcomas. J Surg Oncol. 2014;110(2):115-22.

Dendale R, Lumbroso-Le Rouic L, Noel G, et al. Proton beam radiotherapy for uveal melanoma results of Curie Institut-Orsay proton therapy center (ICPO). Int J Radiat Oncol Biol Phys. 2006;65(3):780-7.

Dennis ER, Bussière MR, Niemierko A, et al. A comparison of critical structure dose and toxicity risks in patients with low grade gliomas treated with IMRT versus proton radiation therapy. Tech Cancer Res Treat. 2013;12(1):1-9.

Desjardins L, Lumbroso-Le Rouic L, Levy-Gabriel C, et al. Combined proton beam radiotherapy and transpupillary thermotherapy for large uveal melanomas a randomized study of 151 patients. Ophthalmic Res. 2006;38(5):255-60.

Dionisi F, Avery S, Lukens JN, et al: Proton therapy in adjuvant treatment of gastric cancer: Planning comparison with advanced x-ray therapy and feasibility report. Acta Oncol. 2014; 53:1312-1320.

Duttenhaver JR, Shipley WU, Perrone T, et al. Protons or megavoltage X-rays as boost therapy for patients irradiated for localized prostatic carcinoma. An early phase I/II comparison. Cancer. 1983;51(9):1599-604.

Eaton BR, MacDonald SM, Yock TI, et al. Secondary malignancy risk following proton radiation therapy. Front Oncol. 2015; 5:261.

Efstathiou JA, Trofimov AV, Zietman AL. Life, liberty, and the pursuit of protons an evidence-based review of the role of particle therapy in the treatment of prostate cancer. Cancer J. 2009;15(4):312-8.

Egger E, Schalenbourg A, Zografos L, et al. Maximizing local tumor control and survival after proton beam radiotherapy of uveal melanoma. Int J Radiat Oncol Biol Phys. 2001;51(1):138-47.

Egger E, Zografos L, Schalenbourg A, et al. Eye retention after proton beam radiotherapy for uveal melanoma. Int J Radiat Oncol Biol Phys. 2003;55(4):867-80.

Esmaeli B, Yin VT, Hanna EY, et al. Eye-sparing multidisciplinary approach for the management of lacrimal gland carcinoma. Head Neck. 2016;38(8):1258-1262.

Fang P, Mick R, Deville C, et al. A case-matched study of toxicity outcomes after proton therapy and intensitymodulated radiation therapy for prostate cancer. Cancer. 2015;121(7):1118-1127.

Feuvret L, Noel G, Calugaru V, et al. Chondromyxoid fibroma of the skull base differential diagnosis and radiotherapy two case reports and a review of the literature. Acta Oncol. 2005;44(6):545-53.

Filippi AR, Ciammella P, Piva C, et al. Involved-site image-guided intensity modulated versus 3D conformal radiation therapy in early stage supradiaphragmatic Hodgkin lymphoma. Int J Radiat Oncol Biol Phys. 2014;89(2):370-375.

Fitzek MM, Linggood RM, Adams J, Munzenrider JE. Combined proton and photon irradiation for craniopharyngioma long-term results of the early cohort of patients treated at Harvard Cyclotron Laboratory and Massachusetts General Hospital. Int J Radiat Oncol Biol Phys. 2006;64(5):1348-54.

Fitzek MM, Thornton AF, Harsh G, et al. Dose-escalation with proton/photon irradiation for Daumas-Duport lower-grade glioma results of an institutional phase I/II trial. Int J Radiat Oncol Biol Phys. 2001;51(1):131-7.

Fitzek MM, Thornton AF, Rabinov JD, et al. Accelerated fractionated proton/photon irradiation to 90 cobalt gray equivalent for glioblastoma multiforme: results of a phase II prospective trial. J Neurosurg. 1999; 91(2):251260.

Fukumitsu N, Sugahara S, Nakayama H, et al. A prospective study of hypofractionated proton beam therapy for patients with hepatocellular carcinoma. Int J Radiat Oncol Biol Phys. 2009; 74(3):831-836.

Funk RK, Tryggestad EJ, Kazemba BD, et al. Dosimetric comparison of IMRT vs. pencil-beam scanning proton therapy for distal esophageal cancer. Proceedings to the 54th Annual Meeting for the Particle Therapy Cooperative Group (PTCOG) and the 2nd Annual Meeting of PTCOG- North America. Int J Particle Therapy. 2015 Summer;2(1): 360-361.

Fuss M, Hug EB, Schaefer RA, et al. Proton radiation therapy (PRT) for pediatric optic pathway gliomas: comparison with 3D planned conventional photons and a standard photon technique. Int J Radiat Oncol Biol Phys. 1999;45(5):1117-1126.

Gardner BG, Zietman AL, Shipley WU, et al. Late normal tissue sequelae in the second decade after high dose radiation therapy with combined photons and conformal protons for locally advanced prostate cancer. J Urol. 2002;167(1):123-6.

Georg D, Hopfgartner J, Gòra J, et al. Dosimetric considerations to determine the optimal technique for localized prostate cancer among external photon, proton, or carbon-ion therapy and high-dose-rate or low-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys. 2014;88(3):715-722.

Gragoudas ES, Egan KM, Seddon JM, et al. Intraocular recurrence of uveal melanoma after proton beam irradiation. Ophthalmology. 1992;99(5):760-6.

Gragoudas ES, Lane AM, Regan S, et al. A randomized controlled trial of varying radiation doses in the treatment of choroidal melanoma. Arch Ophthalmol. 2000;118(6):773-8.

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Sachsman S, Flampouri S, Li Z, et al. Proton therapy in the management of non-Hodgkin lymphoma. Leuk Lymphoma. 2015;56(9):2608-2612.

Sachsman S, Hoppe BS, Mendenhall NP, et al. Proton therapy to the subdiaphragmatic region in the management of Hodgkin lymphoma. Leuk Lymphoma. 2015;56(7):2019-2024.

Sachsman S, Nichols Jr RC, Morris CG, et al. Proton therapy and concomitant capecitabine for non-metastatic unresectable pancreatic adenocarcinoma. Int J Particle Therapy. 2014;1(3):692-701.

Schild ST, Rule WG, Ashman JB, et al. Proton beam therapy for locally advanced lung cancer: a review. World J Clin Oncol. 2014;5(4):568-575.

Schulte RW, Slater JD, Rossi CJ Jr., Slater JM. Value and perspectives of proton radiation therapy for limited stage prostate cancer. Strahlenther Onkol. 2000;176(1):3-8.

Seifert V, Stolke D, Mehdorn HM, Hoffmann B. Clinical and radiological evaluation of long-term results of stereotactic proton beam radiosurgery in patients with cerebral arteriovenous malformations. J Neurosurg. 1994;81:683-9.

Sejpal S, Komaki R, Tsao A, et al. Early findings on toxicity of proton beam therapy with concurrent chemotherapy for nonsmall cell lung cancer. Cancer. 2011;117(13):3004-3013.

Sheets NC, Goldin GH, Meyer AM, et al. Intensity-modulated radiation therapy, proton therapy, or conformal radiation therapy and morbidity and disease control in localized prostate cancer. JAMA. 2012; 307(15):1611-1620.

Shih HA, Arvold ND, Niemierko A, et al. Second tumor risk and projected late effects after proton vs. intensity modulated photon radiotherapy for benign meningioma: a dosimetric comparison. Int J Radiat Oncol Biol Phys. 2010; 78(3): S272.

Shih HA, Sherman JC, Nachtigall LB, et al. Proton therapy for low-grade gliomas: results from a prospective trial. Cancer. 2015;121(10):1712-1719.

Shipley WU, Verhey LJ, Munzenrider JE. Advanced prostate cancer the results of a randomized comparative trial of high dose irradiation boosting with conformal photons compared with conventional dose irradiation using protons alone. Int J Radiat Oncol Biol Phys. 1995;32(1):3-12.

Silander H, Pellettieri L, Enblad P, et al. Fractionated, stereotactic proton beam treatment of cerebral arteriovenous malformations. Acta Neurol Scand. 2004;109(2):85-90.

Simone II CB, Kramer K, O’Meara WP et al. Predicted rates of secondary malignancies from proton versus photon radiation therapy for stage I seminoma. Int J Radiat Oncol Biol Phys. 2012; 82(1): 242-249.

Sio TT, Lin H-K, Shi Q, et al. Intensity modulated proton therapy versus intensity modulated photon radiation therapy for oropharyngeal cancer: first comparative results of patient-reported outcomes. Int J Radiat Oncol Biol Phys. 2016;95(4):1107-1114.
Slater JD. Clinical applications of proton radiation treatment at Loma Linda University review of a fifteen-year experience. Technol Cancer Res Treat. 2006;5(2):81-9.

Slater JD, Rossi CJ, Yonemoto LT, et al. Conformal proton therapy for early-stage prostate cancer. Urology. 1999;53(3):978-84.

Slater JD, Rossi CJ, Yonemoto LT, et al. Proton therapy for prostate cancer the initial Loma Linda University experience. Int J Radiat Oncol Biol Phys. 2004;59(2):348-52.

Slater JD, Yonemoto LT, Rossi CJ Jr, et al. Conformal proton therapy for prostate carcinoma. Int J Radiat Oncol Bio Phys. 1998;42(2):229-304.

Spatola C, Privitera G, Raffaele L, et al. Clinical application of proton beams in the treatment of uveal melanoma The first therapies carried out in Italy and preliminary results (CATANA Project). Tumori. 2003;89(5):502-509.

Spratt DE, Pei X, Yamada J, et al. Long-term survival and toxicity in patients treated with high-dose intensity modulated radiation therapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2013; 85(3):686-92.

Steneker M, Lomax A, Schneider U. Intensity modulated photon and proton therapy for the treatment of head and neck tumors. Radiother Oncol. 2006; 80(2):263-267.

Sugahara S, Oshiro Y, Nakayama H, et al. Proton beam therapy for large hepatocellular carcinoma. Int J Radiat Oncol Biol Phys. 2010; 76(2):460-466.

Sugahara S, Tokuuye K, Okumura T, et al. Clinical results of proton beam therapy for cancer of the esophagus. Int J Radiat Oncol Biol Phys. 2005; 61(1):76-84.

Suit HD, Goitein M, Munzenrider JE, et al. Definitive radiation therapy for chordoma and chondrosarcoma of base of skull and cervical spine. J Neurosurg. 1982;56:377-85.

Suit HD, Urie M. Proton beams in radiation therapy. J Natl Cancer Inst. 1992;84(3):155-64.

Takaoka EI, Miyazaki J, Ishikawa H, et al. Long-term single-institute experience with trimodal bladder-preserving therapy with proton beam therapy for muscle-invasive bladder cancer. Jpn J Clin Oncol. 2017;47(1):67-73.

Takatori K, Terashima K, Yoshida R, et al. Upper gastrointestinal complications associated with gemcitabineconcurrent proton radiotherapy for inoperable pancreatic cancer. J Gastroenterol. 2014;49(6):1074-1080.

Terashima K, Demizu Y, Jin D, et al. A phase I/II study of gemcitabine-concurrent proton radiotherapy for locally advanced pancreatic cancer without distant metastasis. Radiother Oncol. 2012;103(1):25-31.

Thompson RF, Mayekar SU, Zhai H, et al. A dosimetric comparison of proton and photon therapy in unresectable cancers of the head of pancreas. Medical Physics. 2014;41(8Part1):081711-1-081711-10.

Timmermann B. Proton beam therapy for childhood malignancies: status report. Klin Padiatr. 2010;222(3):127-133.

Tolz A, Shin N, Mitrou E, et al. Late radiation toxicity in Hodgkin lymphoma patients: proton therapy’s potential. J Appl Clinic Med Physics. 2015;16(5):167-178.

Tommasino F and Durante M. Proton radiobiology. Cancers. 2015; 7(1):353-381.

Travis LB, Curtis RE, Faumeni Jr. JF et al. Risk of second malignant neoplasms among long-term survivors of testicular cancer. J Natl Cancer Inst. 1997; 89(19): 1429-1439.

Travis LB, Fossa SD, Schonfield SJ, et al. Second cancers among 40,576 testicular cancer patients: focus on longterm survivors. J Natl Cancer Inst. 2005; 97(18); 1354-1365.

Trofimov A, Nguyen PL, Coen JJ, et al. Radiotherapy treatment of early-stage prostate cancer with IMRT and protons: a treatment planning comparison. Int J Radiat Oncol Bioly Phys. 2007;69(2):444-453.

Trofimov A, Nguyen PL, Efstathiou JA, et al. Interfractional variations in the setup of pelvic bony anatomy and soft tissue, and their implications on the delivery of proton therapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2011;80(3):928-937.

Tseng YD, Cutter DJ, Plastaras JP, et al. Evidence-based review on the use of proton therapy in lymphoma from the Particle Therapy Cooperative Group (PTCOG) Lymphoma Subcommittee. Int J Radiat Oncol Biol Phys. 2017;99(4):825-842.

van de Schoot AJ, Visser J, van Kesteren Z, Janssen TM, Rasch CR, Bel A. Beam configuration selection for robust intensity-modulated proton therapy in cervical cancer using Pareto front comparison. Phys Med Biol. 2016;61(4):1780-94.

Vargas C, Fryer A, Mahajan C, et al. Dose-volume comparison of proton therapy and intensity-modulated radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2008;70(3):744-51.

Verma V, Iftekaruddin Z, Badar N, et al. Proton beam radiotherapy as part of comprehensive regional nodal irradiation for locally advanced breast cancer. Radiother Oncol. 2017;123(2):294-298.

Verma V, Simone 2nd CB, and Mishra MV. Quality of life and patient-reported outcomes following proton radiation therapy: a systematic review. J Natl Cancer Inst. 2018;110(4):341-353.

Vernimmen FJ, Harris JK, Wilson JA, et al. Stereotactic proton beam therapy of skull base meningiomas. Int J Radiat Oncol Biol Phys. 2001;49(1):99-105.

Wang J, Wei C, Tucker SL, et al. Predictors of postoperative complications after trimodality therapy for esophageal cancer. Int J Radiat Oncol Biol Phys. 2013;86(5):885-891.

Wang XS, Shi Q, Williams LA, et al. Prospective study of patient-reported symptom burden in patients with nonsmall-cell lung cancer undergoing proton or photon chemoradiation therapy. J Pain Symptom Manage. 2016;51(5):832-838.

Wang Z, Nabhan M, Schild SE, et al. Charged particle radiation therapy for uveal melanoma: a systematic review and meta-analysis. Int J Radiat Oncol Biol Phys. 2013;86(1):18-26.

Weber DC, Chan AW, Bussiere MR, et al. Proton beam radiosurgery for vestibular schwannoma tumor control and cranial nerve toxicity. Neurosurgery. 2003;53(3):577-86.

Weber DC, Rutz HP, Bolsi A, et al. Spot scanning proton therapy in the curative treatment of adult patients with sarcoma: the Paul Scherrer institute experience. Int J Radiat Oncol Biol Phys. 2007;69(3):865-71.

Weber DC, Rutz HP, Pedroni ES, et al. Results of spot-scanning proton radiation therapy for chordoma and chondrosarcoma of the skull base the Paul Scherrer Institut experience. Oncol Biol Phys. 2005;63(2):401-9.

Wenkel E, Thornton AF, Finkelstein D, et al. Benign meningioma partially resected, biopsied, and recurrent intracranial tumors treated with combined proton and photon radiotherapy. Int J Radiat Oncol Biol Phys. 2000;48(5):1363.

Wilkinson B, Morgan H, Gondi V, et al. Low levels of acute toxicity associated with proton therapy for low-grade glioma: a proton collaborative group study. Int J Radiat Oncol Biol Phys. 2016; 96(2S):E135.

Wilson MW, Hungerford JL. Comparison of episcleral plaque and proton beam radiation therapy for the treatment of choroidal melanoma. Ophthalmology. 1999;106(8):1579-87.

Wilt TJ, Shamliyan T, Taylor B, et al. Comparative effectiveness of therapies for clinically localized prostate cancer: An update of a 2008 Comparative Effectiveness Review. March 29, 2013; Available at: https://effectivehealthcare.ahrq.gov/topics/prostate-cancer-therapies-update/research-protocol. Accessed March 13, 2019.

Winkfield KM, Gallotto S, Niemierko A, et al. Proton therapy for mediastinal lymphomas: an 8-year single-institution report. Int J Radiat Oncolo Biol Phys. 2015;93(3 Suppl):E461.

Wo JY, Yeap BY, Delany TF et al. A pilot feasibility study of definitive concurrent chemoradiation with pencil beam scanning proton beam in combination with 5-fluorouracil and mitomycin-c for carcinoma of the anal canal. Journal of Clinical Oncology 36, no. 4_suppl (February 2018) 733-733.

Wolff HA, Wagner DM, Conradi LC, et al. Irradiation with protons for the individualized treatment of patients with locally advanced rectal cancer. Radiotherapy and Oncology. 2012;102(1): 30-37.

Xi M, Xu C, Liao Z, et al. Comparative outcomes after definitive chemoradiotherapy using proton beam therapy versus intensity modulated radiation therapy for esophageal cancer: a retrospective, single-institutional analysis. Int J Radiat Oncol Biol Phys. 2017;99(3):667-676.

Yonemoto LT, Slater JD, Rossi CJ Jr, et al. Combined proton and photon conformal radiation therapy for local advanced carcinoma of the prostate preliminary results of a phase I/II study. Int J Radiat Oncol Bio Phys. 1997;37(1):21-9.

Yoon M, Kim D, Shin DH, et al. Inter- and intrafractional movement-induced dose reduction of prostate target volume in proton beam treatment. Int J Radiat Oncol Biol Phys. 2008;71(4):1091-1102.

Yu JB, Soulos PR, Herrin J et al. Proton versus intensity-modulated radiotherapy for prostate cancer: patterns of care and early toxicity. J Natl Cancer Inst. 2013;105(1):25-32.

Yuh GE, Loredo LN, Yonemoto LT, et al. Reducing toxicity from craniospinal irradiation using proton beams to treat medulloblastoma in young children. Cancer J. 2004;10(6):386-90.

Zacharatou Jarlskog C, Paganetti H. Risk of developing second cancer from neutron dose in proton therapy as function of field characteristics, organ, and patient age. Int J Radiat Oncol Biol Phys. 2008; 72(1):228-235.

Zelefsky MJ, Pei X, Teslova T, et al. Secondary cancers after intensity-modulated radiotherapy, brachytherapy and radical prostatectomy for the treatment of prostate cancer: incidence and cause-specific survival outcomes according to the initial treatment intervention. BJU Int. 2012; 110(11):1696-701.

Zenda S, Kawashima M, Arahira S, et al. Late toxicity of proton beam therapy for patients with the nasal cavity, para-nasal sinuses, or involving the skull base malignancy: importance of long-term follow-up. Int J Clin Oncol. 2015;20(3):447-54.

Zhang X, Zhao KL, Guerrero TM, et al. Four-dimensional computed tomography-based treatment planning for intensity-modulated radiation therapy and proton therapy for distal esophageal cancer. Int J Radiat Oncol Biol Phys. 2008; 72(1):278-287.

Zietman A. Proton beam and prostate cancer: an evolving debate. Reports of Practical Oncol Radiother. 2013;18(6):338-342.

Zietman Al, Bae K, Slater JD, et al. Randomized trial comparing conventional-dose with high-dose conformal radiation therapy in early-stage adenocarcinoma of the prostate: long-term results from Proton Radiation Oncology Group/American College of Radiology 95-09. J Clin Oncol. 2010;28(7):1106-1111.

Zietman AL. The Titanic and the iceberg prostate proton therapy and health care economics. J Clin Oncol. 2007;25(24):3565-6.

Zietman AL, DeSilvio ML, Slater JD, et al. Comparison of conventional-dose vs high-dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate a randomized controlled trial. JAMA. 2005;294(10):1233-9.

Zorlu F, Gurkaynak M, Yildiz F et al. Conventional external radiotherapy in the management of clivus chordomas with overt residual disease. Neurol Sci. 2000;21(4):203–207.

Zurlo A, Lomax A, Hoess A, et al. The role of proton therapy in the treatment of large irradiation volumes: a comparative planning study of pancreatic and biliary tumors. Int J Radiat Oncol Biol Phys. 2000; 48(1):277-288.





Coding

Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

THE FOLLOWING CODES ARE USED TO REPRESENT PROTON BEAM RADIATION TREATMENT DELIVERY

77520, 77522, 77523, 77525

THE FOLLOWING CODES ARE USED TO REPRESENT SERVICES ASSOCIATED WITH PROTON BEAM RADIATION THERAPY
77014, 77263, 77290, 77293, 77295, 77300, 77301, 77307, 77321, 77331, 77332, 77333, 77334, 77336, 77370, 77387, 77427, 77470



Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD - 10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD -10 Diagnosis Code Number(s)

See Attachment A


HCPCS Level II Code Number(s)



MEDICALLY NECESSARY

G6001 Ultrasonic guidance for placement of radiation therapy fields

G6002 Stereoscopic x-ray guidance for localization of target volume for the delivery of radiation therapy



Revenue Code Number(s)

0333 Radiation therapy

Coding and Billing Requirements


Cross References

Attachment A: Proton Beam Radiation Therapy
Description: ICD-10 Diagnosis Codes




Policy History

Revisions from 09.00.49l
07/01/2019Notable Revisions

Policy

Language was revised under the Not Medically Necessary heading.

The following indications were added as Medically Necessary:
  • Intrahepatic Cholangiocarcinoma
  • Malignancies requiring Craniospinal Irradiation (CSI)
  • Pediatric Malignancies

The following indications were added as Not Medically Necessary:
  • Locally advanced Breast Cancer when treating the internal mammary nodes
  • Primary CNS cancer
  • Remaining cases of unresectable hepatocellular carcinoma and intrahepatic cholangiocarcinoma
  • Hodgkin’s Lymphoma
  • Non-Hodgkin's Lymphoma
  • Stage IIIB Non-Small Cell Lung Cancer
  • Pancreatic cancer
  • Retroperitoneal Sarcoma
  • Thymomas and Thymic Carcinoma

The following indications were revised under Not Medically Necessary:
  • Head and neck cancer (not including the brain)
  • Prostate cancer

The following indications were removed from Experimental/Investigational:
  • When delivered in an ablative manner (i.e., Stereotactic Body Radiation Therapy (SBRT))
  • In combination with photon therapy for any tumor
  • For the treatment of laryngeal cancer [stage T1 or T2, cancer has not spread to lymph nodes (N0), and the disease has not metastasized (M0)]

The following indication was revised under Experimental/Investigational:
  • Prostate cancer after prostatectomy

Language addressing code S8030 was removed from the policy.

Coding

Attachment A was created, and all ICD-10 Diagnosis Codes were moved into the Attachment.

The following ICD-10 Diagnosis Codes were added as Medically Necessary:
    C63.7, C63.8

The following ICD-10 Diagnosis Codes were added as Not Medically Necessary:
    C25.0, C25.1, C25.2, C25.3, C25.4, C25.7, C25.8, C25.9, C34.00, C34.01, C34.02, C34.10, C34.11, C34.12, C34.2, C34.30, C34.31, C34.32, C34.80, C34.81, C34.82, C34.90, C34.91, C34.92, C48.0, C48.8, C50.011, C50.012, C50.019, C50.021, C50.022, C50.029, C50.111, C50.112, C50.119, C50.121, C50.122, C50.129, C50.211, C50.212, C50.219, C50.221, C50.222, C50.229, C50.311, C50.312, C50.319, C50.321, C50.322, C50.329, C50.411, C50.412, C50.419, C50.421, C50.422, C50.429, C50.511, C50.512, C50.519, C50.521, C50.522, C50.529, C50.611, C50.612, C50.619, C50.621, C50.622, C50.629, C50.811, C50.812, C50.819, C50.911, C50.912, C50.919, C71.0, C71.1, C71.2, C71.3, C71.4, C71.5, C71.6, C71.7, C71.8, C71.9, C81.00, C81.01, C81.02, C81.03, C81.04, C81.05, C81.06, C81.07, C81.08, C81.09, C81.10, C81.11, C81.12, C81.13, C81.14, C81.15, C81.16, C81.17, C81.18, C81.19, C81.20, C81.21, C81.22, C81.23, C81.24, C81.25, C81.26, C81.27, C81.28, C81.29, C81.30, C81.31, C81.32, C81.33, C81.34, C81.35, C81.36, C81.37, C81.38, C81.39, C81.40, C81.41, C81.42, C81.43, C81.44, C81.45, C81.46, C81.47, C81.48, C81.49, C81.70, C81.71, C81.72, C81.73, C81.74, C81.75, C81.76, C81.77, C81.78, C81.79, C85.10, C85.11, C85.12, C85.13, C85.14, C85.15, C85.16, C85.17, C85.18, C85.19, C85.20, C85.21, C85.22, C85.23, C85.24, C85.25, C85.26, C85.27, C85.28, C85.29, C85.80, C85.81, C85.82, C85.83, C85.84, C85.85, C85.86, C85.87, C85.88, C85.89, C81.90, C81.91, C81.92, C81.93, C81.94, C81.95, C81.96, C81.97, C81.98, C81.99, C85.90, C85.91, C85.92, C85.93, C85.94, C85.94, C85.95, C85.96, C85.97, C85.98, C85.99

The following HCPCS Code was removed from the policy: S8030

Revisions from 09.00.49k
03/01/2019Notable Revisions

Policy

Language was revised under the Medically Necessary, Not Medically Necessary, and Experimental/Investigational headings.

The following indication was added as Experimental/Investigational:
    • For the treatment of laryngeal cancer [stage T1 or T2, cancer has not spread to lymph nodes (N0), and the disease has not metastasized (M0)]

Coding

The following CPT narrative has been revised in this policy: 77387

Revisions from 09.00.49j
10/01/2018Notable Revisions
  • The following Medically Necessary indications were removed:
    • Primary therapy for melanoma of the uveal tract (i.e., iris, choroid, ciliary body), with no evidence of metastasis or extrascleral extension, when the tumors are no more than 24 mm in largest diameter, and 14 mm in height.
    • Postoperative therapy (with or without conventional high-energy X-rays) in individuals who have undergone biopsy or partial resection of chordoma, or low-grade (I or II) chondrosarcoma of the basisphenoid region (skull-base chordoma or chondrosarcoma) or cervical spine. Individuals eligible for this treatment must have residual localized tumor without evidence of metastasis.
    • Central nervous system tumors (i.e., tumors within the skull, skull-based tumors, spinal cord tumors)
    • Benign or malignant intracranial tumors
    • Intracranial arteriovenous malformations
    and replaced with the following indications:
    • Chordomas and chondrosarcomas of the base of the skull, localized and in the postoperative setting
    • Uveal melanoma, when proton beam radiation therapy is considered preferential compared to brachytherapy
    • Localized unresectable hepatocellular carcinoma (HCC)
    • Stage IIA seminoma
  • The following language was added to the policy:
    NOT MEDICALLY NECESSARY
    Proton beam radiation therapy is considered not medically necessary and, therefore, not covered for the treatment of the following tumors because current evidence indicates that proton beam radiation therapy is no more effective than other forms of radiation therapy (e.g., IMRT):
    • Previously untreated prostate cancer
    • Head and neck cancer (not including the brain)
    • Preoperative and definitive treatment of esophageal cancer
  • All language regarding Coverage With Study Participation was removed from the policy.
  • Under Experimental/Investigational, the following language was removed:
    All other uses for proton beam radiation therapy are considered experimental/investigational and, therefore, not covered because their safety and/or effectiveness cannot be established by review of the available published peer-reviewed literature.
    and replaced with the following language:
    Proton beam radiation therapy is considered experimental/investigational and, therefore, not covered for all other indications including the following because the safety and/or effectiveness of this service cannot be established by review of the available published peer-reviewed literature:
    • In the treatment of prostate cancer after prostatectomy
    • When delivered in an ablative manner (i.e., Stereotactic Body Radiation Therapy (SBRT))
    • In combination with photon therapy for any tumor
  • The following CPT Code was added to this policy: 77301
  • The following CPT Codes were removed from this policy because they are not used for Proton Beam billing: 76376, 76377, 77261, 77262, 77280, 77285, 77306, 77417
  • The following ICD-10 Diagnosis Codes were added to this policy:
      Medically Necessary
      C22.0, C22.1, C22.2, C22.3, C22.4, C22.7, C22.8, C22.9, C41.0, C41.9, C62.00, C62.01, C62.02, C62.10, C62.11, C62.12, C62.90, C62.91, C62.92, C69.30, C69.31, C69.32, C69.40, C69.41, C69.42, C69.90, C69.91, C69.92
      Not Medically Necessary
      C01, C02.0, C02.1, C02.2, C02.3, C02.4, C02.8, C02.9, C03.0, C03.1, C03.9, C04.0, C04.1, C04.8, C04.9, C05.0, C05.1, C05.2, C05.8, C05.9, C06.0, C06.1, C06.2, C06.80, C06.89, C06.9, C07, C08.0, C08.1, C08.9, C09.0, C09.1, C09.8, C09.9, C10.0, C10.1, C10.2, C10.3, C10.4, C10.8, C10.9, C11.0, C11.1, C11.2, C11.3, C11.8, C11.9, C12, C13.0, C13.1, C13.2, C13.8, C13.9, C14.0, C14.2, C14.8, C15.3, C15.4, C15.5, C15.8, C15.9, C30.0, C30.1, C31.0, C31.1, C31.2, C31.3, C31.8, C31.9, C32.0, C32.1, C32.2, C32.3, C32.8, C32.9, C33, C47.0, C49.0, C61, C76.0, C77.0, D07.5

Revisions from 09.00.49i
07/02/2018The policy was updated to communicate that this policy applies to self-funded groups for whom eviCore's Radiation Therapy Services program is not applicable.


Effective 10/05/2017 this policy has been updated to the new policy template format.


Version Effective Date: 07/01/2019
Version Issued Date: 07/01/2019
Version Reissued Date: N/A

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