Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery (New Jersey)
Governance of coverage and medical necessity criteria for stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) for adults (19+) in New Jersey; applies to providers and prior authorization/review processes.
Policy applies to individuals 19 years of age and older; SRS and SBRT are covered without further review for individuals younger than 19 years of age.
Revised list of proven and medically necessary indications, including additions for symptomatic non-spine bone metastasis (up to five fractions), neurologic functional conditions refractory to treatment, and expanded spinal lesion criteria.
Oligometastatic disease criteria standardized: performance status wording clarified and total metastatic lesions increased from up to three to up to five.
Added intrahepatic bile duct cancer (cholangiocarcinoma) as a definitive treatment indication for unresectable tumors.
Noted HCPCS code G0563 is not on the State of New Jersey Medicaid Fee Schedule and therefore may not be covered by NJ Medicaid.
Emphasized medical record documentation requirements to support medical necessity; documentation may be requested and does not guarantee coverage.
Updated definitions for 'Definitive Treatment' and 'Oligometastatic Disease (OMD)'.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.