Medicare administrative contractors issued differing policies last week on the use of image guidance with superficial radiation therapy (SRT), with Palmetto proposing to restrict image guidance, while the National Correct Coding Initiative continues allowing it.

Palmetto, which covers the southeast region, released a proposed LCD that concluded there is no evidence to support the use of high-resolution ultrasound (HRUS) for SRT in low-risk NMSCs.

ASTRO subject matter experts attended a Palmetto Contractor Advisory Committee (CAC) meeting on December 5 to discuss the development of this policy and express opposition to the use of daily “image guidance” and simulations to treat superficial skin cancers.

Additionally, the proposed LCD states that HRUS is not considered reasonable or necessary for use in each fractionated treatment, except in certain high-risk cases. ASTRO will be preparing a comment letter in response to the proposal ahead of the open comment period deadline of May 11. Members interested in providing feedback on this LCD should reach out to Emilio Beatley.

National Correct Coding Initiative contractor J29 Solutions emailed a response to ASTRO’s recent comment letter, which urged the agency to modify the current policy that allows for the use of image guidance with SRT in certain circumstances. NCCI told ASTRO it will not implement the ASTRO recommendation. ASTRO will continue efforts to educate NCCI and advocate to end inappropriate use of image guidance.