Intensity Modulated Radiation Therapy (IMRT)

The following information may assist you when working with private payers in your locality to assure appropriate coverage of Intensity Modulated Radiation Therapy (IMRT).  The ACR supports the use of IMRT applications in certain situations under specific parameters.  IMRT is not a new technology, but is a new application of an existing technology (namely, external beam radiation therapy).  Please see the attached example letter and attachments for more detailed information supporting the use of IMRT. 

The following information is included below:

  • An example letter the ACR sent to a member who contacted us regarding the denials of IMRT by a private payer in his locality.  The ACR would be happy to write a similar letter to anyone who provides documentation of the payer’s denial (in the form of a denial letter, EOB, etc).  When forwarding information, please be sure to black out any patient-specific information;
  • The ACR Practice Guideline for Intensity Modulated Radiation Therapy (IMRT);
  • Coding articles from the February 2002 and April 2001 ACR Bulletin, regarding coding for IMRT; and
  • A bibliography of articles that outline the utilization and effectiveness of IMRT.  You may wish to use the literature included on the bibliography as evidence when working with your private payer to help assure appropriate coverage of IMRT. 
     

You may also wish to inform the private payer that the Centers for Medicare and Medicaid Services (CMS) covers IMRT in both the Medicare Physician Fee Schedule and the Hospital Outpatient Prospective Payment System (HOPPS), and that enrollees in a commercial health plan should have the same access to care as Medicare beneficiaries.  In addition to the below coding articles that address IMRT, the American Society for Therapeutic Radiology and Oncology/American College of Radiology (ASTRO/ACR) Radiation Oncology Coding User’s Guide addresses proper coding for IMRT.  For information on how to order a copy of the User’s Guide, please contact the ACR Publication Sales Department at (800) 227-7762.