Pancreatic cancer is a devastating disease with few effective treatment modalities. Stereotactic body radiation therapy is a novel technique that takes advantage of the technologic advancements in image guidance and radiation dose delivery to direct ablative doses to tumors with acceptable toxicity that was not previously achievable with conventional techniques. Recent literature contains repor...

©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...

Background Intensity-modulated stereotactic radiotherapy achieves improvements in the ability to produce conformal stereotactic dose distributions by modulation of the intensity of individually delivered beamlets of radiation. Image-guided intensity-modulated stereotactic radiotherapy has emerged as a new treatment option in the multidisciplinary management of metastatic and locally advanced ca...

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. Please note that payment for covered services is subject to eligibility and ...

Patient Selection Criteria Coverage for the use of stereotactic radiosurgery (SRS) using a gamma or linear-accelerator (LINAC) will be considered when any of the following criteria are met:  Arteriovenous malformations;  Acoustic neuromas;  Pituitary adenomas;  Non-resectable, residual or recurrent meningiomas;  Craniopharyngiomas;  Glomus jugulare tumors;  Solitary or multiple brain met...

The application of nuclear magnetic resonance (NMR) imaging to a stereotactic method is described. The physical properties of NMR offer some important advantages such as good contrast between grey and white matter and the possibility to scan the brain in three planes and at any desired angle. Stereotactic localisation by NMR gives very satisfactory and precise visualisation of the target struct...