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MIR-2006-8A, August 2006
Local Coverage Determinations (LCD) Summary
Providers: If you wish to obtain the full text of the LCDs (and articles) described in this section, they are available on the Empire Medicare Services Web site at: http://www.empiremedicare.com/PartA/parta_lcd.cfm.
Read and accept the CPT License for Use, then click on the “Policies in Notice Period” link or write to:
Empire Medicare Services
P.O. Box 4846
Syracuse , NY 13221-4846
Attention: Coordination Department
Or call the Empire Medicare Services Provider Inquiries Department at 1-888-855-4356.
To receive notification when new policies or updates are posted to our Web site, subscribe to the Empire Medicare Services Local Coverage Determination (LCD) mailing list from the EMS Web site at: http://www.empiremedicare.com/servlist/listservformindex.htm. Then fill in and submit the requested information.
LOCAL COVERAGE DETERMINATION
Local Coverage Determination (LCD) Title: Brachytherapy
Medicare Coverage Database Contractor’s Determination Number: DL447
Notice Period: July 19, 2006 through September 01, 2006
Effective Date: September 02, 2006
LCD Description:
Radiation oncology consists of two primary treatment modalities, external beam radiation therapy (EBRT), and brachytherapy. Brachytherapy is a type of radiation therapy that utilizes natural or manufactured radioactive isotopes or radionuclides that are temporarily or permanently implanted to treat malignancies or certain benign conditions. This is achieved by implanting a radioactive source in the form of wires or seeds, close to or into the tumor or treatment site. Treatment may be delivered from sources that are on the surface of an organ (surface application), implanted in catheters or directly into the tissue (interstitial brachytherapy), introduced into an airway or blood vessel (intraluminal or intravascular brachytherapy), or loaded into catheters/applicators, which are placed in body cavities (intracavitary brachytherapy). Brachytherapy may be used by itself or as an adjunctive treatment in combination with external beam therapy to increase the total dose to a specified target.
Brachytherapy requires the expertise of a team of trained personnel (physician, physicist, dosimetrist, radiation therapist, nurse, and radiation safety officer) to implement the individualized treatment plan designed by the radiation oncologist. The typical requirements of brachytherapy may involve:
- Treatment planning -The radiation oncologist develops the treatment plan. A high dose rate (HDR) or a low dose rate (LDR) brachytherapy may be selected.
- Dosimetry - Both external beam and brachytherapy require certain calculations to be made throughout the course of treatment.
- Treatment Management - The management of brachytherapy includes the review of dosimetry, the review of chart prescription, the review of patient treatment set-up, and the medical evaluation of the patient during the treatment.
- Isodose Planning - Brachytherapy requires the isodose plan to ensure the desired dose of radiation. This plan determines the dose at each implanted source and throughout the treatment volume and doses to surrounding normal tissue.
- Handling and Loading of Radioelement - Where brachytherapy techniques require the manual loading of an isotope (LDR), the supervision, loading and handling of the isotope may be separately reported.
- Sources - The choice and placement of after-loading applicators and the loading and unloading of radioactive sources may be performed by the radiation oncologist alone or in collaboration with another physician (e.g., gynecologist, urologist, pulmonologist).
- Simulation - For brachytherapy, simulation my involve x-ray films of the implanted sources or applicator(s) containing dummy sources. These films of the implanted sources are used to develop isodose curves and other dosimetry.
- Treatment Devices - Treatment devices (e.g., block and wedges) are not typically used with brachytherapy as this modality involves the internal application of radiation. However, there are certain templates that may be required for specific clinical circumstances. These may be covered as treatment devices.
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