CommercialCoverageMedium impact
Brachytherapy or Radioactive Seed Implantation for Prostate Cancer 6.01.16
Excellus BlueCross BlueShield·Oncology, Urology, Radiology·Radiation Treatment
Effective date
Dec 22, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their brachytherapy policy for prostate cancer, effective December 22, 2025, defining specific risk group criteria for when LDR and HDR brachytherapy are medically appropriate as monotherapy or boost therapy. The policy clarifies that HDR brachytherapy alone for high-risk prostate cancer is investigational and not covered.
Action Required
Before December 22, 2025: Radiation oncology and urology billing teams must review patient risk stratification documentation to ensure brachytherapy claims align with the new coverage criteria based on PSA levels, Grade Groups, and clinical staging. Update prior authorization processes to verify patients meet appropriate risk group criteria for monotherapy vs. boost therapy indications. Claims for HDR brachytherapy monotherapy in high-risk patients will be denied as investigational.