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Blue Cross & Blue Shield of MississippiAll Plans · Coverage · Medical Policy · Oncology, Radiation Oncology, NeurosurgeryMedium impact

Intensity-Modulated Radiotherapy (IMRT): Central Nervous System Tumors

Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

IMRT may be considered medically necessary for individuals with malignant or benign brain tumors when the tumor is proximate to organs at risk (brain stem, spinal cord, cochlea, and eye structures) and 3-dimensional conformal radiotherapy planning cannot meet dose-volume constraints for normal tissue tolerance. Hippocampal-avoiding IMRT may be considered medically necessary for individuals with brain tumor metastases outside a 5-mm margin around either hippocampus and expected survival of 4 months or more. IMRT is considered investigational for tumors of the central nervous system for all other indications.

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What to do

Action · 5 steps
01Billing team: bill IMRT for brain tumors as medically necessary only when the tumor is proximate to organs at risk and 3-dimensional conformal radiotherapy planning cannot meet dose-volume constraints for normal tissue tolerance.
02Bill hippocampal-avoiding IMRT as medically necessary for brain tumor metastases outside a 5-mm margin around either hippocampus when expected survival is 4 months or more.
03Bill IMRT for all other central nervous system tumor indications as investigational.
04Bill the covered codes 77301, 77338, 77385, 77386, G6015, and G6016 with the central nervous system diagnosis codes listed in the code reference, and only when the procedure is performed according to the policy section.
05Dosimetry plans may be reviewed to demonstrate that 3-dimensional conformal radiotherapy would exceed tolerance doses to structures at risk.

Codes mentioned

77301773387738577386G6015G6016C70.0C70.9C71.0C71.9C72.0C72.9C79.31C79.32C79.40C79.49D33.0D33.2

Original notice

Intensity-Modulated Radiotherapy (IMRT): Central Nervous System Tumors
bcbsms.com · Always check the source before changing claims.
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Related changes

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Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesOncologyRadiation OncologyNeurosurgeryCode 77301Code 77338Code 77385Code 77386Code G6015Code G6016Code C70.0Code C70.9Code C71.0Code C71.9Code C72.0Code C72.9Code C79.31Code C79.32Code C79.40Code C79.49Code D33.0Code D33.2

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