Coverage Update: Over 22 Million more patients across the US to have increased access to electron based IORT for low risk breast cancer.
Throughout the U.S, based on the growing body of evidence and the updated ASTRO Consensus Statement on APBI, affirming the efficacy of single-treatment electron IORT, many private insurance carriers have updated their medical policies to include electron-beam IORT as medically necessary for low risk breast cancer patients. The latest to do so is AETNA.
According to its website, AETNA proudly serves over 22 million patients in over 5,000 hospitals across the country.
Per the updated policy which is currently effective, electron-beam IORT is the only single treatment radiation therapy technique recognized as medically necessary for qualifying low risk breast cancer patients undergoing breast conserving surgery.
The AETNA Policy States:
AETNA considers the use of single-fraction electron-beam IORT at the time of breast conserving surgery (i.e., lumpectomy) medically necessary for individuals with breast cancer when the following selection criteria are met:
- Documented diagnosis of early stage (I or II) breast cancer
- Negative lymph nodes
- Technically clear surgical margins
- Tumors less than or equal to 5 cm in diameter