Stereotactic Radiosurgery for Metastases to the Brain

Policy issue: Stereotactic radiosurgery (SRS), also known as "Gamma knife surgery", is a specialized form of radiation therapy used to treat a variety of brain abnormalities. SRS is a non-invasive alternative for many patients for whom traditional brain surgery is not an option, and indications for use of SRS now include metastases to the brain. In 1997, VHA managers requested information on the evidence of effectiveness of SRS for this latest indication.

Assessment: VATAP produced a systematic review of the evidence of effectiveness of SRS for the treatment of metastases to the brain, as well as relevant regulatory information.

Stereotactic Radiosurgery for Metastases to the Brain: A Systematic Review of Published Studies of Effectiveness, December, 1997

Current status: SRS is available to eligible patients in VHA. In the past, Medicare had reduced the reimbursement rate for SRS based on estimates of reduced procedure costs relative to open cranial surgery. In December 2003, Medicare issued final billing instructions for 2004 for SRS when it is furnished to beneficiaries in a hospital outpatient department that is paid under the outpatient prospective payment system. See Department of Health and Human Services Centers for Medicare and Medicaid Services, CMS Manual System, Pub. 100-20 One Time Notification. December 19, 2003. http://www.cms.hhs.gov/transmittals/downloads/R32OTN.pdf

Related information:

• Search the The National Guideline ClearinghouseT for evidence-based clinical practice guidelines and related documents on use of SRS: http://www.guideline.gov/



• Search the National Institutes of Health website for ongoing clinical trials of SRS for treatment of brain metastases: www.clinicaltrials.gov