ASTRO is actively
engaged in working with private insurance organizations in areas that impact
coverage and payment of radiation therapy services. ASTRO has established
positive relationships with several private managed care organizations including
Aetna, WellPoint, UnitedHealthcare and others, and we are solicited for our
input on draft medical coverage policies as well as coding issues. This is
accomplished through providing education to private insurers on radiation
therapy services to ensure that medical policies and coverage determinations
appropriately represent the specialty. ASTRO actively monitors and responds to
information published by private insurers as it relates to coverage for
radiation therapy services.
ASTRO staff has been reaching out to non-Medicare payers to understand whether they will accept the 2015 MPFS G-Codes. The tracking document lists those payers we have communicated with and their initial reaction regarding acceptance of the G-codes. It is important to understand that this is a living document that will be updated as new information becomes available.
ASTRO advocates for appropriate coverage of radiation oncology services by engaging in discussions with private managed care organizations and other entities, such as the California Technology Assessment Forum.
Private insurers are hoping to control the increasing costs of radiation treatment delivery and ensure appropriate usage of these services by contracting with ROBMs.