Anthem Medical Policies for Radiation Oncology
| Document # | Medical Policy Title |
| SURG.00143 | Perirectal Spacers for Use During Prostate Radiotherapy |
AIM Clinical Guidelines for Radiation Oncology
Radiation Therapy
The AIM Clinical Appropriateness Guidelines for Radiation Therapy address brachytherapy, intensity-modulated radiation therapy, stereotactic body radiation therapy, and stereotactic radiosurgery.
OPEN THE GUIDELINES FOR RADIATION THERAPY EFFECTIVE MARCH 13, 2022
For commercial and Medicare members
COMING SOON RADIATION THERAPY GUIDELINES EFFECTIVE NOVEMBER 6, 2022
Proton Beam Therapy
The AIM Clinical Appropriateness Guidelines for Proton Beam Therapy address proton beam therapy, also known as proton radiation therapy or proton radiotherapy.
OPEN THE GUIDELINES FOR PROTON BEAM THERAPY EFFECTIVE MARCH 13, 2022
Perirectal Hydrogel Spacer
The AIM Clinical Appropriateness Guidelines for Perirectal Hydrogel Spacer address the use of an implanted hydrogel spacer when radiation therapy is used to treat prostate cancer.
COMING SOON PERIRECTAL HYDROGEL SPACER GUIDELINES EFFECTIVE NOVEMBER 6, 2022
Code cross-reference guide
Download a helpful spreadsheet to find current and archived procedure codes for each solution!Anthem medical policy site:
For a complete listing of Anthem medical policies, please go to Anthem Provider site > select your state > Scroll down page, select Review Policies > view Medical Policies & Clinical UM GuidelinesOther client policy sites:
- Amerigroup Provider site > Select your state
- Healthlink Provider site
- Healthy Blue LA Provider site
- Healthy Blue SC Provider site
- Simply Healthcare site
- Summit Community Care AR Provider site
- Unicare Provider site
Other Clinical Guidelines
Archived Guidelines
For guidelines older than 3 years, please contact AIM.guidelines@aimspecialtyhealth.com
Radiation Therapy (excludes Proton)
- Radiation Therapy effective November 7, 2021 – March 12, 2022 for commercial and Medicare
- Radiation Therapy effective March 14, 2021 – November 6, 2021 for commercial and Medicare
- Radiation Therapy effective February 9, 2020 – March 13, 2021
- Radiation Therapy effective March 9, 2019 – February 8, 2020
- Radiation Therapy effective January 27, 2019 – March 8, 2019
- Radiation Therapy effective January 1, 2018 – January 26, 2019
- Radiation Therapy effective September 5, 2017 – December 31, 2017
- Radiation Therapy effective February 20, 2017 – September 4, 2017
Proton Beam Therapy
- Proton Beam Therapy effective March 14, 2021 – March 12, 2022
- Proton Beam Therapy effective November 10, 2019 – March 13, 2021
- Proton Beam Therapy effective March 9, 2019 – November 9, 2019
- Proton Beam Therapy effective March 12, 2018 – March 8, 2019
- Proton Beam Therapy effective September 5, 2017 – March 11, 2018
- Proton Beam Therapy effective February 20, 2017 – September 4, 2017