Aetna · Clinical coverage policy

Aetna Brachytherapy coverage criteria

Aetna covers brachytherapy (interstitial, intracavitary, or internal radiation therapy) for a defined list of solid tumors — including head and neck, esophagus, rectum/anus, lung/bronchus, breast, gynecologic, prostate, penis, urethra, ocular (retina/choroid), CNS/meninges, and certain secondary tumors — only when the medical-necessity criteria in the EviCore Healthcare Radiation Therapy Clinical Guidelines are met, which is the key gate. Electronic brachytherapy (e.g., AccuBoost, Xoft Axxent eBx) for breast cancer and all other indications, and endovascular/intravascular brachytherapy for restenosis after renal or femoropopliteal angioplasty, are considered experimental and investigational, and the brachytherapy-plus-external-beam combination (ProstRcision) for prostate cancer is not proven more effective than alternatives.

Policy CPB 0371 · Effective · Verify against the current Aetna policy before submitting — view source policy.

Payer

Aetna

Policy

CPB 0371

Prior auth

Confirm

Effective

January 1, 2026

This page reflects the coverage criteria captured from Aetna policy CPB 0371 and may not include every criterion, exception, or code — verify the complete bulletin before submitting.

What this means for the claim

The covered path, the next step to get it approved, and the specific way it denies — built only from this policy.

When does Aetna cover Brachytherapy (CPT 19296), and what gets it denied?

Path
Aetna covers brachytherapy (interstitial, intracavitary, or internal radiation therapy) for a defined list of solid tumors — including head and neck, esophagus, rectum/anus, lung/bronchus, breast, gynecologic, prostate, penis, urethra, ocular (retina/choroid), CNS/meninges, and certain secondary tumors — only when the medical-necessity criteria in the EviCore Healthcare Radiation Therapy Clinical Guidelines are met, which is the key gate. Electronic brachytherapy (e.g., AccuBoost, Xoft Axxent eBx) for breast cancer and all other indications, and endovascular/intravascular brachytherapy for restenosis after renal or femoropopliteal angioplasty, are considered experimental and investigational, and the brachytherapy-plus-external-beam combination (ProstRcision) for prostate cancer is not proven more effective than alternatives. Coverage criteria include: Aetna considers brachytherapy (also known as interstitial radiation, intracavitary radiation, internal radiation therapy) medically necessary for the indications below WHEN medical necessity criteria are met in the EviCore Healthcare Radiation Therapy Clinical Guidelines (the specific medical-necessity criteria are externally maintained in those EviCore guidelines, not enumerated in this bulletin).; Brachytherapy may be used in conjunction with surgery.; Tumors close to critical structures that cannot be resected with adequate surgical margins may also be treated by interstitial brachytherapy.; Brachytherapy may be used either alone or in combination with external beam radiation.; Covered (when selection criteria are met) — malignant neoplasm of the lip.; Covered (when selection criteria are met) — malignant neoplasm of the base of tongue.; Covered (when selection criteria are met) — malignant neoplasm of the soft palate.; Covered (when selection criteria are met) — malignant neoplasm of the cheek mucosa.; Covered (when selection criteria are met) — malignant neoplasm of major salivary gland.; Covered (when selection criteria are met) — malignant neoplasm of the tonsillar fossa.; Covered (when selection criteria are met) — malignant neoplasm of the nasopharynx.; Covered (when selection criteria are met) — malignant neoplasm of the esophagus.; Covered (when selection criteria are met) — malignant neoplasm of the rectosigmoid junction.; Covered (when selection criteria are met) — malignant neoplasm of the rectum, anus, and anal canal.; Covered (when selection criteria are met) — malignant neoplasm of the trachea, bronchus, and lung.; Covered (when selection criteria are met) — melanoma and malignant neoplasms of the skin.; Covered (when selection criteria are met) — malignant mesothelioma of the pleura.; Covered (when selection criteria are met) — malignant neoplasm of the breast.; Covered (when selection criteria are met) — malignant neoplasm of the vulva, vagina, and uterus.; Covered (when selection criteria are met) — malignant neoplasm of the penis.; Covered (when selection criteria are met) — malignant neoplasm of the prostate.; Covered (when selection criteria are met) — malignant neoplasm of the urethra.; Covered (when selection criteria are met) — malignant neoplasm of the retina.; Covered (when selection criteria are met) — malignant neoplasm of the choroid.; Covered (when selection criteria are met) — malignant neoplasm of the cerebral and spinal meninges.; Covered (when selection criteria are met) — malignant neoplasm of the spinal cord, cranial nerves, and other parts of the central nervous system.; Covered (when selection criteria are met) — secondary malignant neoplasm of the lung.; Covered (when selection criteria are met) — secondary malignant neoplasm of the nervous system.; Covered (when selection criteria are met) — carcinoma in situ of the bronchus and lung.; Covered (when selection criteria are met) — benign neoplasm of the bronchus and lung.; Covered (when selection criteria are met) — neoplasm of uncertain behavior of the lung.; Covered (when selection criteria are met) — stenotic obstruction following lung transplantation.. Applies to 16 codes: 19296, 19297, 19298, 20555, 55875, 55876, 57156, 77316, 77317, 77318, 77761, 77762, 77763, 77770, 77771, 77772.
Action
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
Trap
Policy exclusions and limitations: Experimental and investigational — Electronic brachytherapy (e.g., the AccuBoost Technique, and the Xoft Axxent eBx System) for breast cancer and all other indications (e.g., dermatologic indications, and non-melanoma skin cancer), because there is insufficient evidence on its effectiveness; despite proposed safety and logistical advantages, there is insufficient high-quality comparative evidence in the peer-reviewed literature demonstrating equivalent or superior clinical outcomes of electronic brachytherapy compared with established radioisotope-based brachytherapy techniques.; Experimental and investigational — Endovascular / intravascular brachytherapy to reduce re-stenosis following percutaneous renal angioplasty.; Experimental and investigational — Endovascular / intravascular brachytherapy to reduce re-stenosis following percutaneous femoropopliteal angioplasty / peripheral vascular disease.; Not proven more effective than other established alternatives — The combination of brachytherapy and external beam radiation therapy (ProstRcision) has not been proven to be more effective than other established alternatives for the treatment of prostate cancer.; Not covered for the indications listed in this CPB — malignant neoplasm of the pancreas.; Not covered for the indications listed in this CPB — malignant neoplasm of the bladder.; Not covered for the indications listed in this CPB — malignant neoplasm of the brain.; Not covered for the indications listed in this CPB — secondary malignant neoplasm of bone.; Not covered for the indications listed in this CPB — malignant neoplasms of lymphoid, hematopoietic, and related tissue.; Not covered for the indications listed in this CPB — carcinoma in situ of the bladder.; Not covered for the indications listed in this CPB — benign neoplasm of the bladder.; Not covered for the indications listed in this CPB — benign neoplasm of the brain.; Not covered for the indications listed in this CPB — neoplasm of uncertain behavior of the bladder.; Not covered for the indications listed in this CPB — neoplasm of uncertain behavior of the brain and spinal cord.; Not covered for the indications listed in this CPB — neoplasm of unspecified behavior of the bladder.; Not covered for the indications listed in this CPB — neoplasm of unspecified behavior of the brain.; Not covered for the indications listed in this CPB — unspecified macular degeneration / age-related macular degeneration.; Not covered for the indications listed in this CPB — diseases of the skin and subcutaneous tissue (general).; Not covered for the indications listed in this CPB — pustulosis palmaris et plantaris.; Not covered for the indications listed in this CPB — hypertrophic scar / keloid. Claims may be denied when the requested service falls under these.

Source: Aetna CPB 0371 — Brachytherapy

Coverage criteria

  • Aetna considers brachytherapy (also known as interstitial radiation, intracavitary radiation, internal radiation therapy) medically necessary for the indications below WHEN medical necessity criteria are met in the EviCore Healthcare Radiation Therapy Clinical Guidelines (the specific medical-necessity criteria are externally maintained in those EviCore guidelines, not enumerated in this bulletin).
  • Brachytherapy may be used in conjunction with surgery.
  • Tumors close to critical structures that cannot be resected with adequate surgical margins may also be treated by interstitial brachytherapy.
  • Brachytherapy may be used either alone or in combination with external beam radiation.
  • Covered (when selection criteria are met) — malignant neoplasm of the lip.
  • Covered (when selection criteria are met) — malignant neoplasm of the base of tongue.
  • Covered (when selection criteria are met) — malignant neoplasm of the soft palate.
  • Covered (when selection criteria are met) — malignant neoplasm of the cheek mucosa.
  • Covered (when selection criteria are met) — malignant neoplasm of major salivary gland.
  • Covered (when selection criteria are met) — malignant neoplasm of the tonsillar fossa.
  • Covered (when selection criteria are met) — malignant neoplasm of the nasopharynx.
  • Covered (when selection criteria are met) — malignant neoplasm of the esophagus.
  • Covered (when selection criteria are met) — malignant neoplasm of the rectosigmoid junction.
  • Covered (when selection criteria are met) — malignant neoplasm of the rectum, anus, and anal canal.
  • Covered (when selection criteria are met) — malignant neoplasm of the trachea, bronchus, and lung.
  • Covered (when selection criteria are met) — melanoma and malignant neoplasms of the skin.
  • Covered (when selection criteria are met) — malignant mesothelioma of the pleura.
  • Covered (when selection criteria are met) — malignant neoplasm of the breast.
  • Covered (when selection criteria are met) — malignant neoplasm of the vulva, vagina, and uterus.
  • Covered (when selection criteria are met) — malignant neoplasm of the penis.
  • Covered (when selection criteria are met) — malignant neoplasm of the prostate.
  • Covered (when selection criteria are met) — malignant neoplasm of the urethra.
  • Covered (when selection criteria are met) — malignant neoplasm of the retina.
  • Covered (when selection criteria are met) — malignant neoplasm of the choroid.
  • Covered (when selection criteria are met) — malignant neoplasm of the cerebral and spinal meninges.
  • Covered (when selection criteria are met) — malignant neoplasm of the spinal cord, cranial nerves, and other parts of the central nervous system.
  • Covered (when selection criteria are met) — secondary malignant neoplasm of the lung.
  • Covered (when selection criteria are met) — secondary malignant neoplasm of the nervous system.
  • Covered (when selection criteria are met) — carcinoma in situ of the bronchus and lung.
  • Covered (when selection criteria are met) — benign neoplasm of the bronchus and lung.
  • Covered (when selection criteria are met) — neoplasm of uncertain behavior of the lung.
  • Covered (when selection criteria are met) — stenotic obstruction following lung transplantation.

Covered codes

Codes listed in this Aetna policy. Check each one's prior-authorization verdict and Medicare rate:

Frequently asked questions

When does Aetna cover Brachytherapy (CPT 19296), and what gets it denied?
Aetna covers brachytherapy (interstitial, intracavitary, or internal radiation therapy) for a defined list of solid tumors — including head and neck, esophagus, rectum/anus, lung/bronchus, breast, gynecologic, prostate, penis, urethra, ocular (retina/choroid), CNS/meninges, and certain secondary tumors — only when the medical-necessity criteria in the EviCore Healthcare Radiation Therapy Clinical Guidelines are met, which is the key gate. Electronic brachytherapy (e.g., AccuBoost, Xoft Axxent eBx) for breast cancer and all other indications, and endovascular/intravascular brachytherapy for restenosis after renal or femoropopliteal angioplasty, are considered experimental and investigational, and the brachytherapy-plus-external-beam combination (ProstRcision) for prostate cancer is not proven more effective than alternatives. Coverage criteria include: Aetna considers brachytherapy (also known as interstitial radiation, intracavitary radiation, internal radiation therapy) medically necessary for the indications below WHEN medical necessity criteria are met in the EviCore Healthcare Radiation Therapy Clinical Guidelines (the specific medical-necessity criteria are externally maintained in those EviCore guidelines, not enumerated in this bulletin).; Brachytherapy may be used in conjunction with surgery.; Tumors close to critical structures that cannot be resected with adequate surgical margins may also be treated by interstitial brachytherapy.; Brachytherapy may be used either alone or in combination with external beam radiation.; Covered (when selection criteria are met) — malignant neoplasm of the lip.; Covered (when selection criteria are met) — malignant neoplasm of the base of tongue.; Covered (when selection criteria are met) — malignant neoplasm of the soft palate.; Covered (when selection criteria are met) — malignant neoplasm of the cheek mucosa.; Covered (when selection criteria are met) — malignant neoplasm of major salivary gland.; Covered (when selection criteria are met) — malignant neoplasm of the tonsillar fossa.; Covered (when selection criteria are met) — malignant neoplasm of the nasopharynx.; Covered (when selection criteria are met) — malignant neoplasm of the esophagus.; Covered (when selection criteria are met) — malignant neoplasm of the rectosigmoid junction.; Covered (when selection criteria are met) — malignant neoplasm of the rectum, anus, and anal canal.; Covered (when selection criteria are met) — malignant neoplasm of the trachea, bronchus, and lung.; Covered (when selection criteria are met) — melanoma and malignant neoplasms of the skin.; Covered (when selection criteria are met) — malignant mesothelioma of the pleura.; Covered (when selection criteria are met) — malignant neoplasm of the breast.; Covered (when selection criteria are met) — malignant neoplasm of the vulva, vagina, and uterus.; Covered (when selection criteria are met) — malignant neoplasm of the penis.; Covered (when selection criteria are met) — malignant neoplasm of the prostate.; Covered (when selection criteria are met) — malignant neoplasm of the urethra.; Covered (when selection criteria are met) — malignant neoplasm of the retina.; Covered (when selection criteria are met) — malignant neoplasm of the choroid.; Covered (when selection criteria are met) — malignant neoplasm of the cerebral and spinal meninges.; Covered (when selection criteria are met) — malignant neoplasm of the spinal cord, cranial nerves, and other parts of the central nervous system.; Covered (when selection criteria are met) — secondary malignant neoplasm of the lung.; Covered (when selection criteria are met) — secondary malignant neoplasm of the nervous system.; Covered (when selection criteria are met) — carcinoma in situ of the bronchus and lung.; Covered (when selection criteria are met) — benign neoplasm of the bronchus and lung.; Covered (when selection criteria are met) — neoplasm of uncertain behavior of the lung.; Covered (when selection criteria are met) — stenotic obstruction following lung transplantation.. Applies to 16 codes: 19296, 19297, 19298, 20555, 55875, 55876, 57156, 77316, 77317, 77318, 77761, 77762, 77763, 77770, 77771, 77772. Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Policy exclusions and limitations: Experimental and investigational — Electronic brachytherapy (e.g., the AccuBoost Technique, and the Xoft Axxent eBx System) for breast cancer and all other indications (e.g., dermatologic indications, and non-melanoma skin cancer), because there is insufficient evidence on its effectiveness; despite proposed safety and logistical advantages, there is insufficient high-quality comparative evidence in the peer-reviewed literature demonstrating equivalent or superior clinical outcomes of electronic brachytherapy compared with established radioisotope-based brachytherapy techniques.; Experimental and investigational — Endovascular / intravascular brachytherapy to reduce re-stenosis following percutaneous renal angioplasty.; Experimental and investigational — Endovascular / intravascular brachytherapy to reduce re-stenosis following percutaneous femoropopliteal angioplasty / peripheral vascular disease.; Not proven more effective than other established alternatives — The combination of brachytherapy and external beam radiation therapy (ProstRcision) has not been proven to be more effective than other established alternatives for the treatment of prostate cancer.; Not covered for the indications listed in this CPB — malignant neoplasm of the pancreas.; Not covered for the indications listed in this CPB — malignant neoplasm of the bladder.; Not covered for the indications listed in this CPB — malignant neoplasm of the brain.; Not covered for the indications listed in this CPB — secondary malignant neoplasm of bone.; Not covered for the indications listed in this CPB — malignant neoplasms of lymphoid, hematopoietic, and related tissue.; Not covered for the indications listed in this CPB — carcinoma in situ of the bladder.; Not covered for the indications listed in this CPB — benign neoplasm of the bladder.; Not covered for the indications listed in this CPB — benign neoplasm of the brain.; Not covered for the indications listed in this CPB — neoplasm of uncertain behavior of the bladder.; Not covered for the indications listed in this CPB — neoplasm of uncertain behavior of the brain and spinal cord.; Not covered for the indications listed in this CPB — neoplasm of unspecified behavior of the bladder.; Not covered for the indications listed in this CPB — neoplasm of unspecified behavior of the brain.; Not covered for the indications listed in this CPB — unspecified macular degeneration / age-related macular degeneration.; Not covered for the indications listed in this CPB — diseases of the skin and subcutaneous tissue (general).; Not covered for the indications listed in this CPB — pustulosis palmaris et plantaris.; Not covered for the indications listed in this CPB — hypertrophic scar / keloid. Claims may be denied when the requested service falls under these.
Does Aetna require prior authorization for Brachytherapy?
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
What does Aetna exclude for Brachytherapy?
Policy exclusions and limitations: Experimental and investigational — Electronic brachytherapy (e.g., the AccuBoost Technique, and the Xoft Axxent eBx System) for breast cancer and all other indications (e.g., dermatologic indications, and non-melanoma skin cancer), because there is insufficient evidence on its effectiveness; despite proposed safety and logistical advantages, there is insufficient high-quality comparative evidence in the peer-reviewed literature demonstrating equivalent or superior clinical outcomes of electronic brachytherapy compared with established radioisotope-based brachytherapy techniques.; Experimental and investigational — Endovascular / intravascular brachytherapy to reduce re-stenosis following percutaneous renal angioplasty.; Experimental and investigational — Endovascular / intravascular brachytherapy to reduce re-stenosis following percutaneous femoropopliteal angioplasty / peripheral vascular disease.; Not proven more effective than other established alternatives — The combination of brachytherapy and external beam radiation therapy (ProstRcision) has not been proven to be more effective than other established alternatives for the treatment of prostate cancer.; Not covered for the indications listed in this CPB — malignant neoplasm of the pancreas.; Not covered for the indications listed in this CPB — malignant neoplasm of the bladder.; Not covered for the indications listed in this CPB — malignant neoplasm of the brain.; Not covered for the indications listed in this CPB — secondary malignant neoplasm of bone.; Not covered for the indications listed in this CPB — malignant neoplasms of lymphoid, hematopoietic, and related tissue.; Not covered for the indications listed in this CPB — carcinoma in situ of the bladder.; Not covered for the indications listed in this CPB — benign neoplasm of the bladder.; Not covered for the indications listed in this CPB — benign neoplasm of the brain.; Not covered for the indications listed in this CPB — neoplasm of uncertain behavior of the bladder.; Not covered for the indications listed in this CPB — neoplasm of uncertain behavior of the brain and spinal cord.; Not covered for the indications listed in this CPB — neoplasm of unspecified behavior of the bladder.; Not covered for the indications listed in this CPB — neoplasm of unspecified behavior of the brain.; Not covered for the indications listed in this CPB — unspecified macular degeneration / age-related macular degeneration.; Not covered for the indications listed in this CPB — diseases of the skin and subcutaneous tissue (general).; Not covered for the indications listed in this CPB — pustulosis palmaris et plantaris.; Not covered for the indications listed in this CPB — hypertrophic scar / keloid. Claims may be denied when the requested service falls under these.

Source

Aetna CPB 0371 — Brachytherapy

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Coverage disclaimer

This page summarizes Aetna clinical-coverage criteria extracted from policy CPB 0371 for educational purposes. Coverage policies change and vary by individual plan. Always verify against Aetna's current policy before performing a procedure or submitting a claim. d3rx is not responsible for claim denials or reimbursement issues.