Noridian, Medicare Administrative Contractor Retires SBRT Policy

The CyberKnife Coalition is pleased to inform you that Noridian

Administrative Services, the Medicare contractor for Alaska, Arizona, Montana,
North Dakota, Oregon, South Dakota, Utah, Washington and Wyoming, has
retired its SBRT policy, effective April 15, 2011. During a special radiation
oncology webinar on April 13, Noridian officials outlined technical aspects of
the policy retirement related to claims processing, noting specifically that the
automated edits and audits in the system addressed in the policy are deactivated.
Officials confirmed that Noridian has no plans to reactivate the policy at this
time. It appears, therefore, that there will now be no impediments to claims being
paid.
As always, it is the provider’s responsibility to document medical
necessity. Providers should work with Noridian in determining what criteria are
necessary to demonstrate medical necessity. The following are types of
documentation used for this purpose in other Medicare regions:

  • patient selection criteria (stage and other factors);
  • verification that the patient was informed of the range of therapy choices, including the risks and benefits of SBRT; and
  • rationale for choosing SBRT for the patient.

Noridian’s action means there is no longer a negative local coverage decision
in place for prostate SBRT. This is good news for patients and we applaud
Noridian’s decision. With this move only one negative policy remains in place
nationally with regard to prostate SBRT. The Coalition is working with
executives from Medicare contractor Trailblazer to expand patient access in
Colorado, Oklahoma, New Mexico and Texas, the only four states with an active
negative coverage decision for prostate SBRT.