TrailBlazer Medicare Administrative Contractor SBRT Policy Update

The CyberKnife Coalition is pleased to announce that, effective January 30, 2012 TrailBlazer Health Enterprises will begin covering SBRT for prostate cancer in the J4 region (Colorado, New Mexico, Oklahoma, and Texas), provided that patients are enrolled in a clinical study listed on ClinicalTrials.Gov. Use the following link to access TrailBlazer’s website and download a copy of the updated SBRT coverage policy: http://www.trailblazerhealth.com/Tools/LCDs.aspx?ID=2960

In addition to covering diagnosis code 185, carcinoma of the prostate, the new policy provides centers with clear instructions for automated claims processing. Automated processing will allow providers to easily append a modifier for electronic filing and to include the clinical trial number (NCT) for patients enrolled in a clinical study listed on ClinicalTrials.Gov. Please refer to TrailBlazer’s special coding requirements found on the “Article” tab of the policy accessed using the link provided above.
One option for centers looking to meet the clinical study requirement is to join the Registry for Prostate Cancer Radiosurgery (RPCR), established in 2010 by Dr. Mark Perman and Dr. Debra Freeman in Florida to follow patients receiving CyberKnife prostate treatment. This registry is listed on the ClinicalTrials.Gov Web site as: Multi-Institutional Registry for Prostate Cancer Radiosurgery. An IRB Approved Observational Trial, NCT01226004. More information on the registry is available at: http://www.prostateradiosurgery.com. Centers interested in joining should contact Dr. Mark Perman at permanmark@gmail.com.