We’re revising our policy on hypofractionation for breast and prostate cancer as part of our radiation oncology program

Blue Cross Blue Shield of Michigan and Blue Care Network have revised the radiation oncology program, managed through eviCore healthcare, to limit coverage for many breast and prostate cancers to hypofractionation, a shorter, equally effective regimen. This applies to requests submitted on or after Sept. 21.

The new policy applies to Blue Cross commercial, Medicare Plus Blue^SM, BCN commercial and BCN Advantage^SM. It doesn’t apply to Blue Cross self-funded groups.

These changes align with evidence-based guidelines, including those established by the National Comprehensive Cancer Network, or NCCN. They’re expected to result in less frequent visits for patients.

For breast cancer patients, the policy change means that hypofractionation will be covered in cases where the regional lymph nodes aren’t included in the treatment.

For external beam radiation, both hypofractionation (three to four weeks) and standard fractionation (six weeks) are currently allowed. Effective Sept. 21, only hypofractionation (the shorter regimen) will be allowed, although exceptions to this will be made on a case-by-case basis.

For prostate cancer patients, both hypofractionation (four to five weeks) and standard fractionation (nine weeks) are currently allowed. Effective Sept. 21, only hypofractionation (the shorter regimen) will be allowed. Exceptions will be made on a case-by-case basis.

How to submit authorization requests
Submit authorization requests to eviCore in one of these ways:

• Preferred: Use eviCore’s provider portal at evicore.com.**
• Alternative: For Blue Cross and Medicare Plus Blue members, call 1-877-917-2583. For BCN and BCN Advantage members, call eviCore at 1-855-774-1317.
• Alternative: Fax to eviCore at 1-800-540-2406.

For more information, refer to the document titled eviCore Management Program: Frequently Asked Questions.

You can find this document and other resources on our ereferrals.bcbsm.com website:

• The BCN eviCore-Managed Procedures webpage
• The Blue Cross eviCore-Managed Procedures webpage

**Blue Cross Blue Shield and Blue Care Network don’t own or control this website.