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Palmetto/CMS/LCD not covering R sided IMRT APBI
Has anyone else seen this? I'm seeing that in spite of NCCN saying 30/5 IMRT is the preferred APBI approach, Palmetto (the LCD for a huge chunk of the country) is not covering IMRT even for APBI in R sided breast cases. Is this correct? Is this something that is amenable to any appeals? Absolutely insane that a relatively cheap treatment, proven in a phase 3 trial, listed in NCCN guidelines as the preferred technique/fractionation....is not paid for by cms. (Source: Student Doctor Network)
Source: Student Doctor Network - January 31, 2024 Category: Universities & Medical Training Authors: BobbyHeenan Tags: Radiation Oncology Source Type: forums

SBRT vs IMRT for prostate - rad onc is all about money...
I find this video very unprofessional and erroneous in the statements made. It is very disappointing to see rad onc's again portrayed by others as motivated solely by money. Furthermore, the video recommends patients pay out of pocket for a test that has no supporting data and is not FDA approved. "Malpracticy" (Source: Student Doctor Network)
Source: Student Doctor Network - August 9, 2023 Category: Universities & Medical Training Authors: SneakyBooger Tags: Radiation Oncology Source Type: forums

Is 5 Fraction Partial Breast Irradiation SBRT?
ASTRO is developing new partial breast radiation guidelines. There is a draft of the new guidelines online and there is a comments period that ends on July 5th. In these guidelines, they have an accepted techniques section which does not include SBRT. I think 5 fractions partial breast radiation should be considered SBRT, if given with appropriate imaging, machine QA and physician/physics supervision. A 5 fractions IMRT plan would result in a significant decrease in reimbursement compared to... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - July 2, 2023 Category: Universities & Medical Training Authors: radiation123 Tags: Radiation Oncology Source Type: forums

p2p uptick
Is anyone else noticing a serious increase in the number of denials received for what seems like it should be completely obvious? I'm regularly having to do p2ps for IMRT/SBRT denial for reirradiation of the spine (i.e. overlapping, abutting or same segment) in a young metastatic breast patient with otherwise limited disease and excellent KPS. It's bananas. Evicore/Cigna are my most offensive overlords (Source: Student Doctor Network)
Source: Student Doctor Network - May 12, 2023 Category: Universities & Medical Training Authors: SBRTreble Tags: Radiation Oncology Source Type: forums

Insurance Denial of IMRT for Prostate
Anyone here run into this before? I've got a P2P tomorrow with Priority Health. They're denying IMRT for 28-fraction prostate treatment for an intemediate risk prostate cancer. They're telling me they'll only approve brachy or 3D. This is the first time I've ever had IMRT denied for prostate. It's standard of care and am frankly shocked by the denial. Person I'm talking to tomorrow is not a rad onc. They don't have a rad onc to talk to. Are other folks seeing this kind of shenanigans? (Source: Student Doctor Network)
Source: Student Doctor Network - February 17, 2023 Category: Universities & Medical Training Authors: thompa Tags: Radiation Oncology Source Type: forums

NY Presbyterian Gets Paid $97K for 28fx Prostate...
...On a Medicare Advantage patient. Ordinarily, other hospitals and freestanding places will be getting ~$17K max (very few small places have the ability to negotiate >100% Medicare rate)... and that's true even if they're doing 45 fraction IMRT. They also get ~$12K per SBRT fraction on MA patients. "End of tweet" as Jimmy Caan used to say. (Source: Student Doctor Network)
Source: Student Doctor Network - December 31, 2022 Category: Universities & Medical Training Authors: TheWallnerus Tags: Radiation Oncology Source Type: forums

IMRT/VMAT breast/CW
Now that Astro has removed the IMRT for breast from the choosing wisely list, I was wondering if people have been using VMAT for left chest wall or IMRT for left breast in general? Pros and cons? I’ve heard the argument that low dose lung dose is a little higher with VMAT plans for chest wall. But proponents seem to say plans are better overall in some cases. Thoughts? (Source: Student Doctor Network)
Source: Student Doctor Network - October 20, 2022 Category: Universities & Medical Training Authors: radoncle Tags: Radiation Oncology Source Type: forums

Breast IMRT Choosing Wisely... We Knew Ye
Pour one out for ASTRO's Breast IMRT Choosing Wisely. (Ed. note: Love the "recently published evidence" proviso and the past exonerative tense usage.) I believe this is the first ever "withdrawn" Choosing Wisely. Sept 2013: July 2022: (Source: Student Doctor Network)
Source: Student Doctor Network - August 25, 2022 Category: Universities & Medical Training Authors: TheWallnerus Tags: Radiation Oncology Source Type: forums

variant squam with in-transit mets going up the arm
kinda miserable situation for a guy with a bunch of in transit cutaneous mets more or less encompassing the forearm, which are bleeding, etc. Has to wear a whole arm bandage and is beginning to lose function. It's a variant squam and he's a txp patient with no io options who can't tolerate chemo. Got post-op rt to a portion of this area 3 years ago. Wondering what the craziest fields folks have done for situations like these. Whole forearm ap/pa? Arcs/imrt to just the superficial... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - June 4, 2022 Category: Universities & Medical Training Authors: Ray D. Ayshun Tags: Radiation Oncology Source Type: forums

IMRT vs 3D for gastric MALT
Which are people generally doing? (Source: Student Doctor Network)
Source: Student Doctor Network - May 10, 2022 Category: Universities & Medical Training Authors: Ray D. Ayshun Tags: Radiation Oncology Source Type: forums

SDN is tasked with designing an APM system - how do you do it?
I think a lot of people in the rad onc community still see value in an APM/bundling , as @RealSimulD has posted about, but the RO-APM version was seen as a bad attempt. Recent posts about breast IMRT raise the point - if there was no difference in payer cost, we could use whatever technology we thought best. Besides, the definitions are all made up (2D vs 3D for palliation, field in field breast vs 'TRUE' IMRT) and more importantly, IMRT is just as fast if not (usually) faster to... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - May 8, 2022 Category: Universities & Medical Training Authors: jondunn Tags: Radiation Oncology Source Type: forums

IMRT coverage for skin
For patient with node positive squamous of the skin I always have trouble getting IMRT covered for Medicare patients. When I see talks or ASTRO conference presentations they are always using IMRT. Anybody able to get IMRT covered for Medicare patients and why can't I? My billing folks tell me I can get medial canthus C44.121 covered but thats about it. Any tips for codes to use? (Source: Student Doctor Network)
Source: Student Doctor Network - April 16, 2022 Category: Universities & Medical Training Authors: xrt123 Tags: Radiation Oncology Source Type: forums

PP offer - please advise
I am currently a hospital employee, a few years out BC. I work in a small town (no prior connections here, no family, etc). The practice is good with new machines, good support staff, good morale among department, I do a lot of SBRT/SRS/IMRT. I am paid well at MGMA median. I recently met with a solo rad onc owner in a top large metro where I have friends and family. He operates two practices, bills globally and pays rent to the hospital. He offered me a contract to work for him as an... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - March 29, 2022 Category: Universities & Medical Training Authors: LostResident1 Tags: Radiation Oncology Source Type: forums

Pelvic IMRT and Vaginal Dilators
look at the pic. in the eyes of MDACC, if you arent putting a vaginal cylinder in your female anal cancer patients, you arent doing it right (Source: Student Doctor Network)
Source: Student Doctor Network - February 22, 2022 Category: Universities & Medical Training Authors: jondunn Tags: Radiation Oncology Source Type: forums

Severe Procotitis from prostate radiation
I would appreciate your advice and help on this case: 66 yo male with high risk prostate cancer, ADT then IMRT 70 GY in 28 fractions done 6 months ago. He started to have mild rectal bleeding one month ago, scoped by GI and saw tipical procotitis, started on concervative medication management, now requires hospitalization with one unit of blood infusion. It seems there is not a concensus on next step of managment: Despite good clinical success with endoscopic therapies, especially during an... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - December 22, 2021 Category: Universities & Medical Training Authors: windcolour99 Tags: Radiation Oncology Source Type: forums