Oncology | ACGHolmes

Oncology

Oncology Combined Algorithms

Cancer Therapy Pathways Program

Antineoplastics

Harvard Pilgrim Commercial
Tufts Commercial
Tuft Health Direct

Injectable, Infused, or Implanted Drugs

Pharmacogenomics Testing for FDA Known Gene-Drug Interactions

Neutron Beam & Proton Beam Radiation Therapy

External Beam Teletherapy, Brachytherapy, IMRT, SBRT SRS, IORT, and IGRT

Oncology Pharmaceuticals

Radiation Therapy

Brachytherapy-Oncologic Applications

Chemotherapy Observation or Inpatient Hospitalization

Disease Based Radiation Oncology

Aetna

Cigna

FloridaBlue

Fractionation, Image-Guidance, & Special Services

Hyperthermia Treatment for Cancer (Local, Regional & Whole Body)

Aetna

Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Image Guided Radiation Therapy

Implantable Beta-Emitting Microspheres for Treatment of Malignant Tumors

Inpatient Admission for Radiation Therapy

Inpatient Admission for Radiation Therapy for Cervical or Thyroid Cancer

Intensity Modulated Radiation Therapy (IMRT)

Oncologic Applications of Photodynamic Therapy

Aetna

Proton & Neutron Beam Radiation Therapy

Point32

Selective Internal Radiation Therapy (SIRT) for Primary & Secondary Hepatic Malignancy

Stereotactic Radiosurgery (SRS) & Stereotactic Body Radiation Therapy (SBRT)

Stereotactic Radiosurgery (Intracranial)

Tumor Treatment Fields (TTF) Therapy for Glioblastoma

Aetna

Radiation Therpy

Locoregional Techniques for Treating Primary & Metastatic Liver Malignancies

Therapeutic Radiopharmaceuticals

Anthem

Indicates Non-covered Service

Cancer Vaccines

Aetna

Amplitude-Modulated Radiofrequency Electromagnetic Fields Therapy

Cigna

Florida AHCA Drug Criteria:
Oral Oncology

Medicare

Intensity-Modulated Radiotherapy of the Breast & Lung

Intensity-Modulated Radiotherapy: Cancer of the Head and Neck or Thyroid

Radioembolization for Primary & Metastatic Tumors of the Liver

Charged-Particle (Proton or Helium Ion) Radiotherapy for Neoplastic Conditions

Radiofrequency Ablation of Primary or Metastatic Liver Tumors

Oncologic Applications of Positron Emission Tomography Scanning (Genitourinary)

Cryoablation of Tumors Located in the Kidney, Lung, Breast, Pancreas, or Bone

Low Level Laser Therapy

Focal Treatments for Prostate Cancer

FEP

Saturation Biopsy for Diagnosis, Staging, & Management of Prostate Cancer Description

FEP

Gene Expression Profiling & Protein Biomarkers for Prostate Cancer Management Description

FEP

Hematopoietic Cell Transplantation

BCBSIL-BCBSMT-BCBSNM-BCBSOK-BCBSTX-

BCBSIL
BCBSMT
BCBSNM
BCBSOK
BCBSTX

Anthem

BCBSIL
BCBSMT
BCBSNM
BCBSOK
BCBSTX

Molecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, & Treatment Decisions

Specialty Oncology for FDA Approved & Off Label Use

Anthem

Aetna

Cigna

Elder

Indicates Non-covered Service

Commercial

Pediatric

FloridaBlue

Humana

Medicare

MA

Sleep Testing

FloridaBlue

UHC

Medicaid

Aetna

Anthem

FloridaBlue

Cigna

Medicare

UHC

Humana

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