Electronic brachytherapy for nonmelanoma skin cancer (NMSC)
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This policy addresses coverage and medical necessity determinations for electronic brachytherapy used to treat nonmelanoma skin cancer (NMSC) for Medicare Advantage and commercial products of Blue Cross Blue Shield - Rhode Island.
No material clinical or coverage changes in this revision.
Coverage Determination
Coverage determination
Coverage stance differs by product:
Use of CPT code 0394T (High dose rate electronic brachytherapy, skin surface application, per fraction) when billed with ICD-10 diagnosis codes in the range C44.00–C44.99 is explicitly not covered for Medicare Advantage Plans and is considered not medically necessary for Commercial Products.
Services determined to be not medically necessary or that are non‑covered benefits are excluded from payment. Providers should not expect payment for such services from the plan and must follow applicable billing rules and agreements.
For Commercial Products, electronic brachytherapy for nonmelanoma skin cancer is considered not medically necessary. Specifically, submission of CPT 0394T with ICD-10 codes in the range C44.00–C44.99 will be processed as not medically necessary under this policy.
When a service is determined to be not medically necessary or a non‑covered benefit, the provider may receive a denial of payment and may not bill the member for the service unless the member was informed and provided written agreement in advance to accept financial responsibility. Verify member benefits and follow the participation and billing provisions in your contract.
Coding and Diagnosis
| 0394T | High dose rate electronic brachytherapy, skin surface application, per fraction, includes basic dosimetry, when performed. |
| C44.00 - C44.99 | Malignant neoplasm of skin (ICD-10 range for nonmelanoma skin cancers) |
Provider Requirements and Billing Guidance
Prior Authorization Required
Prior authorization is not required for high dose rate electronic brachytherapy (CPT 0394T) per this policy.
Denial for Listed CPT/ICD Pair
Filing CPT 0394T (High dose rate electronic brachytherapy, skin surface application, per fraction) with an ICD-10 diagnosis in the range C44.00–C44.99 will be denied. This service is considered not covered for Medicare Advantage Plans and not medically necessary for Commercial Products when billed with those ICD-10 codes.
- Affected CPT: 0394T
- Affected ICD-10 range: C44.00 - C44.99
Step Therapy / Treatment Sequencing
There is no formal step therapy required by this policy. Clinical guidance favors surgical management as the most effective treatment for nonmelanoma skin cancer (NMSC). When surgery is not feasible or preferred, consider alternatives such as cryosurgery, topical therapy, or radiotherapy; radiotherapy (including external-beam and certain brachytherapy techniques) may be appropriate when surgery would cause unacceptable cosmetic/functional outcomes or is contraindicated by clinical factors.
- Prefer surgical excision when feasible
- Consider radiotherapy when surgery is not appropriate
Benefit Verification and Claim Submission Guidance
Benefits and eligibility vary by contract. Verify member-specific coverage and prior authorization requirements through the provider call center or provider portal before rendering services. Note that non-covered or not medically necessary services may be denied and, unless the member has provided informed written consent to self-pay, you may not bill the member for denied services.
- Contact provider call center or portal to verify benefits and any prior authorization needs
- If service is determined not medically necessary or non-covered, follow consent and billing rules per participation agreement
Clinical Background
Nonmelanoma skin cancers (NMSC) primarily include basal cell carcinoma and squamous cell carcinoma. The most effective and commonly used treatment is surgical excision. Radiotherapy, including modalities such as brachytherapy or electronic brachytherapy, is an alternative when surgery is not feasible or when lesion location (for example near the eyelid or on cosmetically sensitive areas) or patient factors preclude surgery. Electronic brachytherapy delivers localized high‑dose‑rate radiation using a miniaturized X‑ray source and surface applicators to target superficial, well‑circumscribed skin tumors.
Key Definitions
Policy Revision History
Policy effective date set for clinical coverage stance on electronic brachytherapy for nonmelanoma skin cancer.
Policy last reviewed; references and evidence base updated, including citation list and NCCN guideline versions noted.
NCCN Basal Cell Skin Cancer guideline (Version 2.2025) accessed on May 22, 2025 and cited in references.
NCCN Squamous Cell Skin Cancer guideline (Version 2.2025) accessed on May 27, 2025 and cited in references.
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