Medicare AdvantageCoverageMedium impact
Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy - Medicare Advantage (Revised)
Humana·IL, MN, WI, CT, MA, ME, NH, NY, RI, VT, AL, GA, TN, NC, SC, VA, WV · Radiation Oncology, Neurosurgery, Oncology +1 more·Medicare Advantage
Effective date
Feb 2, 2026
We identified it
Jun 24, 2026
Summary
Updated Medicare Advantage coverage policy for stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) with refined criteria for prostate rectal spacers, including specific medical necessity requirements and exclusions for patients with posterior extraprostatic extension or rectal wall invasion.
Action Required
Before February 2, 2026: Billing team must update prior authorization processes for stereotactic radiation therapy procedures to verify patients meet specific criteria, especially for prostate rectal spacer procedures (CPT 55874) which require documentation that patient has no posterior extraprostatic extension or rectal wall invasion. Update encounter forms to prompt providers to document these exclusion criteria. Review current SRS/SBRT cases to ensure compliance with updated LCD requirements in applicable jurisdictions.