Clinical Review Criteria Superficial Radiation Therapy (Electronic Brachytherapy for Non-Melanoma Skin Cancer)
Clinical review criteria for use of superficial electronic brachytherapy (EBT/EBX/eBT) for treatment of non-melanoma skin cancer (NMSC) for Kaiser Foundation Health Plan of Washington members, including Medicare-specific notes and applicable billing codes. Defines coverage stance, evidence conclusions, documentation to submit, and lists applicable procedure and diagnosis codes.
Added the July 2024 MTAC Review.
MPC approved MTAC's recommendation of insufficient evidence and maintain the policy of non-coverage.
Updated applicable codes by adding: 77280, 77285, 77300, 77336, 77370, 77401 and G6001 with applicable skin cancer diagnosis.
Removed deactivated CPT code 0182T and CPT code 77401 (historical note).
Added MTAC review (04/05/2016) and later guideline references (NCCN, Hayes).
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