The following Protocol contains medical necessity criteria that apply for this service. The criteria are also applicable to services provided in the local Medicare Advantage operating area for those members, unless separate Medicare Advantage criteria are indicated. If the criteria are not met, reimbursement will be denied and the patient cannot be billed. Please note that payment for covered s...

©2017 Blue Cross and Blue Shield of Louisiana An independent licensee of the Blue Cross and Blue Shield Association No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission from Blue Cross and Blue Shield of Louisiana. Page 1 of 46 Applies to all products admin...

When Policy Topic is covered Stereotactic radiosurgery using a gamma or LINAC unit may be considered medically necessary for the following indications:  arteriovenous malformations;  acoustic neuromas;  pituitary adenomas;  non-resectable, residual, or recurrent meningiomas;  craniopharyngiomas;  glomus jugulare tumors;  solitary or multiple brain metastases in patients having good perfo...

The following Protocol contains medical necessity criteria that apply for this service. It is applicable to Medicare Advantage products unless separate Medicare Advantage criteria are indicated. If the criteria are not met, reimbursement will be denied and the patient cannot be billed. Preauthorization is not required except for the treatment of cancers of the prostate, breast, lung, colon and ...

When Policy Topic is covered Stereotactic radiosurgery using a gamma or LINAC unit may be considered medically necessary for the following indications:  arteriovenous malformations;  acoustic neuromas;  pituitary adenomas;  non-resectable, residual, or recurrent meningiomas;  craniopharyngiomas;  glomus jugulare tumors;  solitary or multiple brain metastases in patients having good perfo...

The following protocol contains medical necessity criteria that apply for this service. The criteria are also applicable to services provided in the local Medicare Advantage operating area for those members, unless separate Medicare Advantage criteria are indicated. If the criteria are not met, reimbursement will be denied and the patient cannot be billed. Please note that payment for covered s...

Seven patients with large arteriovenous malformations (AVMs) of the brain were selected for combined therapy with particulate embolization, followed by radiosurgery of the residual nidus. The goal of embolization was to reduce the patient nidus to a size that facilitated successful stereotactic radiosurgery. Angiograms obtained 1 and 2 years after radiosurgery were evaluated for changes in nidu...

Overview: Stereotactic Radiosurgery (SRS) is a distinct discipline that utilizes externally generated ionizing radiation in certain cases to inactivate or eradicate (a) defined target(s) in the head and spine without the need to make an incision. The target is defined by high-resolution stereotactic imaging. SRS typically is performed in a single session, using a rigidly attached stereotactic g...

Many cancer patients will develop spinal metastases. Local control is important for preventing neurologic compromise and to relieve pain. Stereotactic body radiotherapy or spinal radiosurgery is a new radiation therapy technique for spinal metastasis that can deliver a high dose of radiation to a tumor while minimizing the radiation delivered to healthy, neighboring tissues. This treatment is b...

Radiosurgery is a therapeutic technique to deliver high dose radiation to the target. It induces radiobiological responses of lesions while minimizing radiation effect to the surrounding area. Gamma knife is one of the representative devices for stereotactic radiosurgery, which is exclusively designed for treatment of cerebral disorders. Gamma knife was developed as the first radiosurgical devi...