CommercialCoverageMedium impact
Brachytherapy After Breast-Conserving Surgery 6.01.30
Excellus BlueCross BlueShield·Oncology, General Surgery·Radiation Treatment
Effective date
Dec 22, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their brachytherapy after breast-conserving surgery policy effective December 22, 2025, establishing specific medical necessity criteria for accelerated partial breast irradiation (APBI) coverage. The policy defines two sets of clinical criteria for coverage approval and declares certain brachytherapy methods as investigational/not covered.
Action Required
By December 22, 2025: Clinical staff must verify all brachytherapy patients meet the specific medical necessity criteria outlined in the policy before treatment authorization. Update prior authorization checklists to include BRCA status, age requirements, tumor size measurements, margin widths, and receptor status. Inform providers that intra-operative breast radiotherapy and electronic brachytherapy are considered investigational and will not be covered.