Radiation Therapy: Fractionation, Image-Guidance, and Special Services (Idaho Only)
This policy outlines medically necessary radiation therapy protocols for conditions like breast cancer and lung cancer, effective April 1, 2026.
- Publisher
- UnitedHealthcare
- Published
- Length
- 23 pages
- File
- 546 KB PDF
Download the full 23-page PDF
Free · 546 KB · Instant access after email
This medical policy from UnitedHealthcare details the coverage criteria for radiation therapy in Idaho, focusing on specific cancer treatments.
- Up to 10 fractions for palliative treatment of bone metastases.
- Up to 33 fractions for breast adenocarcinoma under certain conditions.
- Up to 35 fractions for locally advanced non-small cell lung cancer.
- Guidelines for image-guided radiation therapy (IGRT) usage.
- Documentation requirements for medical necessity.
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