Model Policy Coverage of Proton Therapy

Proton therapy is a technologically advanced method to deliver curative radiation doses to cancerous tumors. The unique characteristics of how protons interact within the human body allow the delivery of radiation doses to a tumor while reducing radiation doses to surrounding healthy tissues and organs, resulting in fewer complications and side effects than standard radiation therapy. Understanding how proton therapy works provides patients, providers, payers, policymakers, and other stakeholders with insight into the clinical advantages of this treatment modality.

This document is intended as a model coverage policy for proton therapy. This model policy identifies under which clinical indications such therapy is clinically appropriate to administer to patients.