Coverage Policies
The Centers for Medicare and Medicaid (CMS) have a number of vehicles for communicating and receiving feedback on coverage policies to ensure appropriate coverage and coding of radiation therapy services.
CMS provides coverage for items and services based on policies primarily developed on a local level, called local coverage determinations (LCDs). These policies are developed by contractors that pay Medicare claims, however in certain cases CMS deems it appropriate to develop a national coverage determination (NCD) for an item or service which is then applied on a national basis for all Medicare beneficiaries meeting the criteria for coverage. CMS also utilizes the Medicare Evidence Development and Coverage Advisory Committee (MedCAC) in making coverage determinations.
ASTRO closely follows these policies and submits letters in response to draft LCDs, NCDs and coding issues published by CMS, advocating for appropriate coverage and payment for radiation therapy services.
Comment letters submitted in response to CMS coverage determinations.
- Comments on Noridian IMRT LCD (6/14)
- Comments on Noridian SRS/SBRT LCD (6/14)
- Cahaba GBA (J10) draft LCD (DL33070) on proton beam therapy (4/13)
- ASTRO and ASCO comment on CMS’s Proposed Decision Memorandum for Position Emission Tomography (FDG) for Solid Tumors (CAG-00181R4) (4/13)
- Novitas Inc. (JH) draft LCD (DL33093) on proton beam therapy (3/13)
- Cahaba GBA (J10) draft LCD (DL32973) on SRS and SBRT(12/12)
- Palmetto GBA (J1) draft LCD (DL28272) on intensity modulated radiation therapy (11/12)
- Noridian draft LCD (DL24473) on non-covered services (7/12)
- Noridian draft LCD for SRS and SBRT (4/12)
- National government services’ guidance for reporting CPT code 77427 (4/12)
- Palmetto GBA’s prepayment medical review for radiation oncology procedure codes (4/12)
- Noridian administrative services draft LCD on stereotactic radiation therapy: stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) (12/11)
- Highmark Medicare services with regards to draft LCD for stereotactic radiosurgery (SRS) (7/11)
- Highmark Medicare services draft LCD for radiation therapy services - addendum (3/11)
- Highmark Medicare services draft LCD for radiation therapy services (3/11)
