ASTRO has successfully secured exclusion of high-resolution ultrasound (HRUS) and electronic brachytherapy in a proposed draft Local Coverage Determination for SRT of non-melanoma skin cancers (NMSC). Released on May 15, the proposed LCD is a multi-jurisdictional Medicare Administrative Contractor (NGS, WPS, Palmetto, Noridian, CGS) effort to curb inappropriate use of RT services.

ASTRO has advocated for several years with CMS officials seeking an exclusion of these services related to the treatment of non-melanoma skin cancers. In October 2024, ASTRO participated in a multi-jurisdictional Carrier Advisory Committee (CAC) meeting to address the misuse of daily image guidance with superficial treatments.

The proposed LCD references ASTRO and American Academy of Dermatology (AAD) clinical practice guidelines that HRUS is not medically necessary and acknowledges the significant limitations in a study arguing that HRUS improves the effectiveness of SRT. ASTRO is in full support of the proposed LCD, as it will effectively end billing of daily ultrasound/image guidance with superficial treatments. However, ASTRO will note in comments that only a board-certified clinical radiation oncologist should perform the procedure.