UnitedHealthcare IMRT Coverage & Prior Auth Update

Coverage Criteria for IMRT

Proven / Medically Necessary Indications

IMRT is considered proven and medically necessary for definitive therapy to the primary site for the following conditions:

listed_sites: Anus/anal canal cancer; Breast cancer when left-sided internal mammary nodes are treated or for accelerated partial breast irradiation (APBI) up to 5 fractions; Central nervous system (CNS) tumors (primary or benign) including brain, brainstem, and spinal cord; Cervical cancer; Endometrial cancer; Esophageal cancer; Head and neck cancers (including lymphoma and solitary plasmacytomas) when treatment includes pharynx (nasopharynx, oropharynx, hypopharynx), larynx (stage III/IV glottic cancer), salivary glands, oral cavity (including tongue), nasal cavity, paranasal sinuses; Mediastinal tumors (e.g., lymphomas, thymomas) including tracheal cancer; Non-small cell lung cancer, stage III, undergoing chemoradiation; Pancreatic cancer; Prostate cancer; Vulvar cancer

Explicit list of proven indications

Special proven services / conditions

Additional proven or medically necessary IMRT usages:

compensator_and_HA-WBRT: Compensator-based beam modulation when performed in combination with an above-listed IMRT indication; Hippocampal-avoidance whole brain radiation therapy (HA-WBRT) up to 10 fractions when ALL of the following are met: brain metastasis present; ECOG performance status ≤ 2 or KPS ≥ 70; prognosis ≥ 4 months; absence of leptomeningeal disease.10 fractions for HA-WBRT

HA-WBRT criteria enumerated in policy

Case-by-case exceptions (may be covered)

IMRT may be covered for indications not listed above when at least one of the following is present:

exception_conditions

toxicity_plan_comparison: A clinically appropriate radiation dose with a non-IMRT technique would increase the probability of clinically meaningful normal tissue toxicity as specified by RTOG/QUANTEC and this is demonstrated on a comparison of IMRT and non-IMRT treatment plans (e.g., 3D-CRT).
Requires plan comparison
prior_radiation_adjacent_area: The same or an immediately adjacent area has been previously irradiated and dose distribution must be sculpted to avoid exceeding cumulative normal tissue tolerance (supports re-irradiation).
Supports re-irradiation scenarios

Not medically necessary / Unproven

unproven: Use of IMRT in conjunction with proton beam radiation therapy is unproven and not medically necessary due to insufficient evidence of efficacy.

Explicit exclusion of combined IMRT+proton use

Site-specific evidence-supported uses

IMRT is supported by evidence or guideline recommendation in these contexts when delivered with appropriate planning and organ-at-risk constraints

Anal cancer — concurrent chemoradiation: IMRT or dose-painted IMRT for nonmetastatic anal cancer treated with concurrent chemoradiation is associated with reduced treatment breaks, reduced some acute and late toxicities, improved completion of chemotherapy cycles, and in large cohort analyses improved overall survival compared with non-IMRT techniques.

Supported by cohort analyses and RTOG 0529 phase II results

Breast cancer — whole-breast or partial-breast irradiation: APBI delivered with IMRT in selected early breast cancer patients yields low ipsilateral breast tumor recurrence with less acute and late toxicity and improved cosmesis versus whole-breast RT; IMRT with respiratory control (DIBH) reduces cardiac and lung doses when treating left-sided internal mammary nodes.

Supported by randomized trials (Meattini et al., Jagsi et al.)

Central nervous system tumors: IMRT is effective for complex-shaped CNS tumors (e.g., skull-base meningiomas) and for large-volume IDH-mutant grade 3 gliomas with good long-term control and functional outcomes; guidelines support use of targeted conformal RT including IMRT for selected CNS indications.

Site-specific coverage rationale

Site-specific evidence and guideline statements relevant to coverage decisions:

CNS tumors: Guidelines and series support IMRT (and other targeted conformal RT) for complex-shaped CNS tumors to improve local control and spare critical structures; for medulloblastoma, timely postoperative craniospinal irradiation is associated with better outcomes and IMRT or proton CSI are viable options per NCCN.

Sources: Mills, Milker-Zabel, Rieken, NCCN

Cervical cancer: Randomized and observational studies and guideline statements support pelvic IMRT to reduce acute and late GI and GU toxicity compared with 3D-CRT without compromising overall or disease-free survival; PET-based IG-IMRT may further reduce hematologic toxicity.

Includes Padhi, Mell, Lin meta-analysis

Endometrial cancer: Phase III randomized data (Klopp et al.) and ASTRO guidance strongly recommend pelvic IMRT for adjuvant treatment to reduce acute and late toxicities and improve patient-reported outcomes versus standard four-field RT.

Patient-reported QOL favored IMRT

Evidence summaries informing coverage

Summary of evidence statements relevant to coverage decisions:

Esophageal dose-escalation RCT (Hulshof et al.): Dose escalation to 61.6 Gy versus standard 50.4 Gy did not significantly improve local control or survival and had numerically higher severe toxicity; routine escalation is not supported without clear justification.

Hulshof et al. RCT

IMRT reduces cardiac and lung dose: Comparative studies and meta-analyses demonstrate IMRT produces lower irradiated volumes to heart and lung versus 3D-CRT, which can support IMRT when OAR sparing is clinically important.

Xu et al., Kole et al.

Head & neck — xerostomia and dysphagia benefits: Randomized trials show parotid-sparing IMRT reduces grade ≥2 xerostomia and DO-IMRT improves patient-reported swallowing (MDADI) compared with standard approaches, supporting IMRT when salivary or swallowing structures are OAR priorities.

Nutting et al., Nutting et al. DO-IMRT trial

HA-WBRT indication

Covered when guideline or trial criteria are met:

HA-WBRT plus memantine is indicated for patients receiving WBRT who have no metastases within approximately 5 mm of the hippocampus, have expected survival ≥ 4 months, and have ECOG ≤ 2 or KPS ≥ 70; randomized trial data (NRG CC001) show preserved cognitive function versus WBRT+memantine without differences in OS or intracranial PFS.no hippocampal lesions; prognosis >=4 months

Supported by NRG CC001 and guideline endorsements

Site-specific IMRT indications

Covered when ALL of the following are met:

IMRT for head and neck cancers: IMRT is preferred to reduce long-term toxicity by sparing salivary glands, temporal lobes, auditory and optic structures and may be used across multiple head and neck subsites per NCCN guidance.N/A

NCCN 2024 guidance

IMRT for mediastinal lymphoma: IMRT may be used to improve conformity and reduce high-dose exposure to heart, esophagus, and spinal cord while adhering to dose constraints; recognize potential increased low-dose bath and weigh risks/benefits.N/A

Systematic review supports reduced high-dose OAR volumes

IMRT for stage III NSCLC with concurrent chemo: IMRT is supported when it reduces cardiac and pulmonary dose without compromising target coverage, based on secondary analysis of RTOG 0617 showing lower heart V40 and reduced grade ≥3 pneumonitis with IMRT versus 3D-CRT.

Evidence summaries by disease site

Evidence summaries supporting IMRT use in specific tumor sites:

Pancreatic cancer evidence: Retrospective and systematic review data show IMRT reduces acute and late GI toxicities versus 3D-CRT while maintaining comparable OS and PFS in available studies.

Umezawa et al., Bittner et al.

Prostate cancer evidence: Long-term institutional series and randomized phase III data demonstrate IMRT provides acceptable tumor control with significantly less acute and late GU/GI toxicity than 3D-CRT.

Abu-Gheida et al., Viani et al.

Vulvar cancer evidence: Retrospective series report high clinical and pathologic response rates and acceptable dose-dependent toxicity with dose-escalated IMRT in locally advanced vulvar cancer; guidelines recommend IMRT for adjuvant settings.

Richman, Rishi, Rao; ESGO 2023

The policy excludes combined-modality treatment plans that mix IMRT with proton beam radiation therapy. Use of IMRT in conjunction with proton therapy is described as unproven and not medically necessary due to insufficient evidence of efficacy; reviewers should treat requests proposing a single treatment plan that combines photon IMRT and proton delivery as unsupported by the clinical literature.

A randomized trial (Hulshof et al., 2021) compared standard definitive chemoradiation of esophageal cancer using 50.4 Gy versus a dose-escalation regimen to 61.6 Gy. The trial found no significant improvement in local progression‑free survival or overall survival with dose escalation; subgroup analyses for squamous cell carcinoma and adenocarcinoma likewise showed no benefit. These randomized data indicate that routine escalation from 50.4 Gy to 61.6 Gy does not improve disease control.

In the Hulshof et al. randomized trial the higher‑dose arm experienced numerically greater severe toxicity (higher rates of grade 4–5 events), and overall conclusions state that escalation to 61.6 Gy did not increase local control or survival compared with 50.4 Gy. The absence of benefit together with increased serious adverse events supports a policy position that routine dose escalation to 61.6 Gy for definitive chemoradiation is not supported by current evidence and requires explicit justification (for example, clinical trial enrollment or compelling patient‑specific rationale).

Hippocampal‑avoidance whole brain radiotherapy (HA‑WBRT) is covered only when guideline and trial criteria are satisfied. Coverage requires that patients have brain metastases, good performance status (ECOG ≤2 or KPS ≥70), an expected prognosis of ≥4 months, and no metastases in the hippocampal‑avoidance region or leptomeningeal disease. These eligibility requirements are consistent with randomized trial evidence showing cognitive benefit with HA‑WBRT plus memantine versus standard WBRT plus memantine.

No clinical evidence supports the combined use of IMRT and proton beam radiation therapy within a single treatment plan. The literature search identified no studies demonstrating safety or efficacy for combined‑plan IMRT+proton delivery, and the policy explicitly notes absence of supporting evidence for this practice.

Consistent with the lack of supporting literature, the policy restates that IMRT delivered in combination with proton beam therapy is considered unproven and not medically necessary. Providers proposing combined IMRT/proton strategies should be prepared to document trial enrollment or present robust clinical justification, recognizing that routine combined‑plan billing/authorization is not supported.

Based on randomized data (Hulshof et al.), routine escalation of definitive chemoradiation dose to 61.6 Gy for esophageal cancer did not demonstrate improved local control or survival compared with the standard 50.4 Gy regimen. As such, escalation to 61.6 Gy in routine practice lacks demonstrated benefit and would generally be considered unsupported without clear, case‑specific justification or clinical trial participation.

The randomized evidence does not support routinely delivering radiation doses above the established standard for esophageal cancer (for example, increasing to 61.6 Gy). Higher prescribed doses were not associated with improved oncologic outcomes and were linked to higher rates of severe toxicity in the trial, indicating dose escalation above standard care should not be routine and requires justification.

Randomized evidence in stage III unresectable non‑small cell lung cancer (Bradley et al.) evaluated high‑dose radiotherapy (up to 74 Gy) delivered with concurrent chemotherapy versus standard‑dose therapy. The trial found that the higher dose was not superior to the standard dose and did not improve outcomes, supporting the conclusion that routine dose escalation to substantially higher levels is not beneficial in this setting.

Provider Actions, Prior Authorization, and Documentation

Prior Authorization

Prior Authorization, Coding, and Coverage

Prior authorization and documentation are required for advanced radiation techniques (IMRT, HA‑WBRT, VMAT, DIBH, IGRT, PBT) when requested. Inclusion of procedure codes in the policy does not guarantee coverage; benefit plan terms and medical necessity determinations apply.

Prior authorization requests should explicitly state the prescribed total dose, fractionation, and technique (e.g., 50.4 Gy in 28 fractions with 3D‑CRT vs 61.6 Gy in 28 fractions with dose escalation using IMRT).
Requests for IMRT/HA‑WBRT must document the intended technique and rationale for using an advanced modality rather than a less conformal approach.

Note

Guideline‑Supported Indications

Guideline-endorsed indications and practice guidance should be referenced in authorization decisions. National and specialty society guidance may support coverage of IMRT/VMAT/HA‑WBRT for specific tumor sites and scenarios when dose constraints or organ‑at‑risk (OAR) sparing are required.

ACR and ESMO recommendations support IMRT/VMAT for anal cancer with specified OAR dose constraints.
NCCN guidance may be used to inform prior authorization for pancreatic, head and neck, CNS, Hodgkin lymphoma, thymic, and other cancers where IMRT/VMAT or HA‑WBRT is described.
ASTRO/ASCO/SNO recommendations support offering HA‑WBRT plus memantine to eligible patients receiving WBRT.
When guideline-supported indications are present, authorization should still document that the proposed plan adheres to the guideline dose constraints and intent.

Documentation Required

Clinical Justification for Advanced RT Techniques

Prior authorization must include clear clinical justification for selecting IMRT or HA‑WBRT over less advanced techniques. Justification should describe the specific OARs at risk, expected clinically meaningful reduction in normal tissue dose or toxicity, and how the chosen technique achieves that benefit.

Provide comparative dosimetry when available (e.g., DVH comparisons between IMRT and 3D‑CRT showing reduced mean dose to salivary glands, cochlea, heart, lungs, or other relevant OARs).
Document prior irradiation to adjacent/overlapping volumes when cumulative dose sculpting is required.
If a less conformal technique (e.g., 3D‑CRT) could provide equivalent target coverage and OAR protection, document why IMRT is still clinically necessary.

Prior Authorization

HA‑WBRT Prior Authorization Eligibility

For HA‑WBRT, document eligibility criteria: absence of metastases within 5 mm of the hippocampus, no leptomeningeal disease, expected survival ≥ 4 months, and appropriate performance status. Authorization should note concurrent memantine use when applicable.

Confirm brain MRI demonstrating no disease in hippocampal avoidance region (within 5 mm of hippocampi).
Document ECOG ≤ 2 or KPS ≥ 70 and estimated prognosis ≥ 4 months.
State planned fractionation (e.g., 30 Gy in 10 fractions) and memantine prescription if intended.

Documentation Required

Required Treatment Planning and Documentation

Treatment planning and delivery documentation are required for review and must be included with prior authorization and retrospective reviews.

Submit treatment intent (definitive, adjuvant, palliative), tumor site and stage, prescription dose and fractionation, and concurrent systemic therapy.
Include the approved radiation therapy treatment plan, dose‑volume histograms (DVHs) for targets and OARs, target and normal structure contours, and planning CT/MRI/PET images used for simulation.
Provide details of delivery technique (IMRT, VMAT, helical IMRT, proton, IGRT), immobilization, and planned verification/QA procedures. Real‑time or protocol QA results should be provided for trial-associated or complex IMRT deliveries.
Document expected start date and note any factors that might delay initiation; timely initiation (for some tumors, e.g., medulloblastoma, cervical cancer) is associated with improved outcomes and delays beyond recommended intervals should be justified.

Documentation Required

Necessary Clinical Documentation Elements

Necessary clinical record elements must be present for medical necessity review and claims adjudication.

Patient identifiers, diagnosis (ICD‑10), staging and prior treatments (surgery, systemic therapy, prior RT)
Radiation prescription: total dose, dose per fraction, number of fractions, intended boost volumes and simultaneous integrated boost details if used
Specific technique and delivery codes requested (CPT/HCPCS) and whether compensator‑based modulation, MLC use, or proton compensation is planned
Planned OAR constraints and the expected dose reductions compared with non‑IMRT techniques; when applicable, provide comparative plan metrics (e.g., lung V20, heart mean dose)
For esophageal dose escalation or other site‑specific dose variations, indicate the intended escalation regimen (e.g., 61.6 Gy to gross tumor) and supporting rationale.

Documentation Required

Radiation Quality Assurance

Radiation quality assurance (QA) and verification are essential. Provide QA documentation when IMRT delivery is complex, when treatment is part of a clinical trial, or when prior authorization requests cite trial‑based evidence.

Include machine QA records, patient‑specific IMRT QA (e.g., gamma analysis), and image‑guided verification logs when available.
Real‑time QA data or protocol compliance reports should be included for treatments derived from clinical trial protocols.

Billing Rule

Coding and Billing Note

Coding listed in this policy is for reference only and does not constitute authorization or guarantee of payment. Benefit plan coverage, bundling rules, and local payer billing policies determine final eligibility and reimbursement.

When submitting authorization or claims, include both the treatment technique CPT/HCPCS codes and the clinical documentation supporting medical necessity.
Requests to combine IMRT and proton therapy in a single plan are unsupported by clinical evidence and require strong justification if billed or requested together.

Note

Modality Preference and Therapy Sequencing

Modality selection and sequencing should reflect guideline and evidence‑based considerations. In some disease sites IMRT is preferred to reduce long‑term toxicities, but preference should be documented and tied to clinical objectives.

NCCN and specialty society guidance support IMRT preference in head and neck, CNS, Hodgkin lymphoma, pancreatic, anal, esophageal, and other cancers where OAR sparing yields clinically meaningful benefit.
Document sequencing considerations and rationale when IMRT is used in multimodality therapy (e.g., chemoradiation, adjuvant RT) and note that IMRT may reduce certain toxicities but not necessarily improve overall survival for all sites.
When less conformal techniques suffice, document tumor and OAR characteristics and provide comparative planning showing why IMRT remains necessary.

Note

FDA Device Information

FDA device information is provided for informational purposes only. Device clearance does not imply coverage.

Refer to FDA product codes MUJ and IYE for information about devices used in IMRT delivery: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm
Device approvals should not be used as the sole basis for determining medical necessity.

Note

None Specified

None specified in this section.

Background and Rationale

External beam radiation therapy (EBRT) delivers high‑energy photon, electron, or proton beams to treat cancer. Intensity‑modulated radiation therapy (IMRT) is an advanced EBRT technique that modulates beam intensity across multiple small volumes to allow conformal dosing to complex three‑dimensional target shapes while sparing adjacent normal tissues; image guidance (IGRT) is commonly used with IMRT to maximize delivery accuracy.

Site-specific evidence-supported uses

IMRT is supported by evidence or guideline recommendation in these contexts when delivered with appropriate planning and organ-at-risk constraints

Anal cancer — concurrent chemoradiation: IMRT or dose-painted IMRT for nonmetastatic anal cancer treated with concurrent chemoradiation is associated with reduced treatment breaks, reduced some acute and late toxicities, improved completion of chemotherapy cycles, and in some large retrospective analyses improved overall survival versus non-IMRT techniques.

Supported by cohort analyses and RTOG 0529 phase II results

Supported by randomized trials (Meattini et al., Jagsi et al.)

Case series, RCT and guideline support

Site-specific coverage rationale

Site-specific evidence and guideline statements relevant to coverage decisions:

Sources: Mills, Milker-Zabel, Rieken, NCCN

Includes Padhi, Mell, Lin meta-analysis

Patient-reported QOL favored IMRT

Definitions and Terms

IMRT (definition)

DefinitionIntensity-modulated radiation therapy (IMRT) is an advanced, high-precision external beam radiation therapy that uses computer-controlled linear accelerators to modulate beam intensity across multiple small volumes to conform dose to the three-dimensional tumor shape while minimizing dose to adjacent normal tissues.

Typical useDelivered to concentrate higher radiation dose in tumor subvolumes while sparing critical structures (per ACR descriptions).

Delivery systemsImplemented using computer-controlled multi‑leaf collimators and treatment planning systems to shape and modulate beam intensity.

IGRT (definition)

DefinitionImage-guided radiation therapy (IGRT) employs imaging during planning and delivery to improve accuracy and to adapt therapy to anatomic, positional, or biologic changes over time.

Role with IMRTOften used in conjunction with IMRT to maximize targeting precision and verify daily setup.

Imaging modalitiesMay include CT, cone-beam CT, PET, or other imaging for target delineation and treatment verification.

HA-WBRT (definition and limits)

DefinitionHippocampal-avoidance whole brain radiotherapy (HA-WBRT) is whole-brain RT delivered using techniques that minimize dose to the hippocampal region to preserve cognitive function.

Coverage fraction limitCovered up to 10 fractions when policy criteria are met.

Eligibility criteriaCoverage applies when brain metastasis is present, ECOG ≤2 or KPS ≥70, prognosis ≥4 months, and absence of leptomeningeal disease and no metastases within the hippocampal‑avoidance region.

Concurrent medicationOften delivered with memantine per guideline and trial evidence (HA-WBRT plus memantine regimens reported).

DP-IMRT (definition)

DefinitionDose‑painted IMRT (DP‑IMRT) is an IMRT technique that prescribes different dose levels to separate subvolumes (e.g., elective nodal volumes vs gross tumor), enabling simultaneous differential dosing within a plan.

Clinical exampleUsed in protocols such as RTOG 0529 for anal cancer with stage‑based differential dose prescriptions to tumor and elective nodal PTVs.

PurposeFacilitates toxicity reduction while delivering escalated doses to gross disease where appropriate.

DIBH (definition)

DefinitionDeep inspiration breath hold (DIBH) is a respiratory control technique used during radiation delivery to increase separation between chest structures and reduce cardiac and pulmonary dose, particularly for left-sided breast irradiation.

Use with IMRTFrequently combined with IMRT or VMAT to further reduce dose to heart and lungs per NCCN guidance.

PurposeAims to lower long‑term cardiac and pulmonary toxicity by altering intrathoracic geometry during treatment delivery.

Targeted conformal RT (definition)

DefinitionTargeted conformal radiation therapy (including 3D‑CRT and IMRT) refers to techniques that shape dose distributions to target volumes to minimize dose to adjacent normal tissues.

Clinical rationaleRecommended by NCCN and ASTRO in specific tumor types to spare important organs‑at‑risk while achieving local tumor control.

IncludesEncompasses 3D‑CRT, IMRT, VMAT and other conformal delivery methods used when organ‑sparing is clinically important.

DO‑IMRT (definition)

DefinitionDysphagia‑optimized IMRT (DO‑IMRT) is an IMRT planning approach that prioritizes sparing of dysphagia‑ and aspiration‑related structures to improve swallowing outcomes.

Supporting evidencePhase III randomized trials (e.g., Nutting et al. for parotid‑sparing; DO‑IMRT RCTs) demonstrate improved patient‑reported swallowing or reduced xerostomia when OAR‑sparing approaches are used.

Intended benefitReduces radiation dose to pharyngeal constrictors and related structures to decrease dysphagia and aspiration risk.

SIB‑IMRT (definition)

DefinitionSimultaneous integrated boost IMRT (SIB‑IMRT) delivers different dose levels to different target volumes within the same treatment session or fractionation schedule.

Clinical useUsed in head and neck and nasopharyngeal cancers to treat low‑ and high‑risk PTVs concurrently (e.g., SEQ vs SIB comparisons in NPC trials).

BenefitProvides convenience and potential radiobiologic advantages by delivering differential doses without separate boost phases.

HA‑WBRT (definition variant)

DefinitionHA‑WBRT (variant): whole‑brain radiotherapy delivered with IMRT techniques to minimize hippocampal dose, commonly combined with memantine to preserve cognitive function.

EvidencePhase III trial (NRG CC001/Brown et al.) showed HA‑WBRT plus memantine reduced cognitive failure versus WBRT plus memantine without differences in OS or intracranial PFS.

Eligibility noteGuidelines recommend HA‑WBRT for patients without metastases near the hippocampus and with adequate prognosis (≥4 months).

Advanced RT technologies (list)

Included modalitiesAdvanced RT technologies include IMRT/VMAT, deep‑inspiration breath hold (DIBH), respiratory gating, image‑guided RT (IGRT), and proton beam therapy (PBT).

PurposeThese technologies are used to spare organs‑at‑risk while achieving target coverage, particularly in patients with curative intent or long expected survival.

Guideline contextNCCN and other guidelines note these modalities may offer clinically relevant advantages in specific instances and emphasize adherence to dose constraints.

PTV and OAR tradeoff (NCCN)

NCCN statementNCCN states that 3D‑CRT, IMRT, and SBRT can improve planning target volume (PTV) coverage while decreasing dose to organs‑at‑risk (OARs); IMRT is increasingly used to escalate dose to gross tumor while minimizing surrounding tissue dose.

Tradeoff noteWhile conformal techniques improve high‑dose conformity, they may increase low‑dose exposure (‘low‑dose bath’); adherence to dose constraints is essential to minimize risk to high‑risk OARs.

Clinical implicationChoice of modality should balance PTV coverage improvements against OAR dose reduction and documented comparative planning when justification is required.

77301	Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications.
77338	Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per IMRT plan.
77385	Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; simple.
77386	Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex.
77387	Guidance for localization of target volume for delivery of radiation treatment, includes intrafraction tracking, when performed.
77520	Proton treatment delivery; simple, without compensation.
77522	Proton treatment delivery; simple, with compensation.
77523	Proton treatment delivery; intermediate.
77525	Proton treatment delivery; complex.

OpenPayer

Intensity-Modulated Radiation Therapy

Coverage Criteria for IMRT

Provider Actions, Prior Authorization, and Documentation

Procedure and Billing Codes

Background and Rationale

Definitions and Terms

Policy Revision History