We are pleased to announce that eviCore, a large Radiation Benefit Manager (RBM) for dozens of commercial insurance plans, including the large national payers Aetna and CIGNA, has posted a revised draft policy improving its recommendations on the use of SRS for brain metastases. As background, eviCore posted a draft policy on its website in January, 2018 (effective on April 1, 2018) that no longer considered the use of stereotactic radiosurgery (SRS) after surgical resection of metastatic brain lesions medically necessary. In addition, this draft policy also stated that fractionated SRS for multiple brain metastases would be approved on a case-by-case basis only after a peer-to-peer review.
To address these issues, the CyberKnife Coalition led a stakeholder initiative requesting eviCore rescind this restrictive language and replace it with language more reflective of published literature and standard of care documented in the NCCN guidelines. On May 6, 2018 eviCore posted updated clinical guidelines that will become effective on August 1, 2018. The policy has been improved overall for both single and fractionated SRS for brain tumors.