All PlansCoverageMedium impact
Intensity-Modulated Radiotherapy: Breast and Lung
Blue Cross Blue Shield of Rhode Island·RI · Oncology, Radiology·Physician / Facility
Effective date
Jul 1, 2022
We identified it
Jun 19, 2026
Summary
Effective July 1, 2022, Intensity-Modulated Radiotherapy (IMRT) may now be considered medically necessary for right-sided breast cancer when the right breast measures greater than 500 cm3 and all other medical criteria are met. This expands coverage criteria for a specific subset of breast cancer patients requiring radiation therapy.
Action Required
By July 1, 2022: Billing team must review complete medical policy criteria for IMRT coverage requirements. Update prior authorization processes to include breast volume measurements (>500 cm3) for right-sided breast cancer cases. Ensure documentation includes all required medical criteria before submitting IMRT claims for breast cancer patients.