Proton Beam Therapy (Re-review)

Proton beams have less scatter radiation than other sources of energy (e.g., gamma rays and x-rays). Because of this feature, proton beam can deliver high doses of radiation to the tumor while limiting the “scatter” dose received by surrounding tissues. Proton beam therapy is used to treat tumors located deep within the body and close to critical organs and body structures.

Coverage decision: Covered with conditions (Effective date: October 1, 2019).

Authorization requirements


Is authorization required?

How do I get pre-authorization?

Yes

L&I (State fund): Complete the Preauthorization Form and fax to:(360) 902-4567

For self-insured: Contact the employer or its third party administrator.

Regulatory authority and related information

 

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