Medical Coverage Policy Electronic Brachytherapy for Nonmelanoma Skin Cancer
This policy addresses coverage of electronic (high-dose-rate) skin-surface brachytherapy for treatment of nonmelanoma skin cancer (NMSC) for Blue Cross Blue Shield - Rhode Island commercial and Medicare Advantage products, including coverage stance and applicable codes.
Policy updated most recently 08/02/2023 with no clinical policy statement changes indicated in the document.
Coverage Summary
This policy addresses coverage of electronic (high-dose-rate) skin-surface brachytherapy for the treatment of nonmelanoma skin cancer (NMSC). The policy scope covers Blue Cross Blue Shield - Rhode Island Commercial and Medicare Advantage products and explicitly lists applicable CPT and ICD-10 codes. Electronic brachytherapy is considered not covered / not medically necessary because the evidence is insufficient to determine the effects of the technology on health outcomes.
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