Coverage of Conditions and Treatments (Coverage Decisions)
Use this lookup tool to determine coverage decisions, or if prior authorization is needed for the treatment or condition. Note: For Self-insured employer claims, you must contact the employer or their claims administrator.
List also available in PDF format.
See Treatment Guidelines and Resources for additional information.
Intensity modulated radiation therapy (IMRT) is a form of external beam radiation therapy (EBRT) to treat certain cancers. The goal of this newer technique is two-fold: to improve the targeting of radiation to the tumor to minimize damage to normal tissue and increase the dose of radiation delivered to the tumor. IMRT is used as primary treatment or in conjunction with surgery, hormonal therapy and/or chemotherapy.
Conditions of Coverage
- For head and neck cancers and prostate cancer, to spare adjacent critical structures to prevent toxicities within expected life span; or
- For undergoing treatment in the context of evidence collection/submission of outcome data (e.g., registry, observational study).
Background Policy Information
The State Health Technology Clinical Committee (HTCC) reviewed IMRT on September 21, 2012. The committee’s determination, based on a systematic review of the evidence of safety, efficacy and cost-effectiveness, is that IMRT is a covered benefit with conditions. Complete information on this HTCC determination is available here: What we're working on | Washington State Health Care Authority.
Implementation of the Determination
IMRT may be used only for care of a condition accepted on the claim. All requests require prior authorization.