First Coast Service Operations (FCSO) SRS-SBRT Coverage Decision Announced
First Coast Service Options (FSCO) SRS-SBRT Coverage Decision Announced
On August 20th, First Coast Service Options (Florida Medicare) posted the final Local Coverage Determination for SRS/SBRT(see link below).
The revised LCD, effective on October 5, 2009, will provide access to CyberKnife treatment for patients with cancerous and noncancerous conditions in the head, neck, and body. For the treatment of cancerous conditions, primary and metastatic lesions may be treated with curative intent or to improve local control rates. Treatment with palliative intent for selected lesions of the spine, pancreas and liver may also be covered.
Covered indications include those in the head, neck, spine, lung, liver, pancreas, kidney, adrenal gland. Please see the policy for a complete list of covered indications and coverage criteria.
Treatment of prostate cancer with SBRT is addressed in the limitations section of the LCD with the following notes:
“For prostate cancer, claims will be developed (documentation requested) for medical review and payment considered on an individual case by case basis. Documentation should include the information noted above, as well as the following information:
• Patient selection (stage and other favorable factors).
• Verification that the patient was informed of the range of therapy choices, including the risks and benefits of SBRT (especially the risk of long term toxicities).
• The rationale for SBRT as a treatment choice for the patient”.
In addition, the following comments were published by the contractor regarding prostate treatment documentation in response to public comments submitted.
• “Other factors considered favorable for payment of the treatment delivery include enrollment of the patient in an appropriate clinical registry (that includes tracking of late toxicities) for planned assessment and publication.”
• “A well designed clinical trial would be favorable information.”
A full version of the posted comments and contractor responses can be found using the following link: http://medicare.fcso.com/Draft_comments/155452.asp
Thanks to all the physicians, patients, and other stakeholders who joined in this effort. We’d like to extend a special thank you to CyberKnife Coalition member and President of the Florida Robotic Radiosurgery Association, Dr. Mark Perman, for his tireless commitment to protecting patients’ access throughout this process.
Prior to the First Coast LCD, three other Medicare contractors have released draft SRS/SBRT LCDs with open public comment periods in the past two years. Due to similar multi-stakeholder efforts in these regions, all three LCDs have been expanded to cover prostate cancer under specified criteria.
These successes are a clear indication that, working together, we can make a difference!
The updated First Coast policy may be viewed at: http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=30366&lcd_version=2&show=all