| Required by BCBS TX policy BCBSTX-RAD-DEMO | Source in chart | Match | Status |
|---|---|---|---|
Histologic confirmation C-1 · §I.1 | Mastectomy pathology Jul 9, 2026 · US Oncology Pathology · p. 1 | Exact | Included |
Stage and extent of disease C-2 · §I.2 | CT chest/abdomen/pelvis Jun 18, 2026 · Baylor Radiology · p. 1 | Exact | Included |
Performance status C-3 · §I.3 | Radiation oncology consult Aug 27, 2026 · R. Lee, MD · p. 1 | Exact | Included |
Tumor board or multidisciplinary review C-4 · §I.4 | Breast tumor board Aug 31, 2026 · Breast Tumor Board · p. 1 | Exact | Included |
Comparative photon plan C-5 · §II.1 | Comparative plan report Sep 12, 2026 · K. Bhatt, CMD · p. 1 | Exact | Included |
Left breast: mean heart dose for both plans C-6 · §III.A.1 | Comparative plan report — cardiac DVH Sep 12, 2026 · K. Bhatt, CMD · p. 1 | Exact | Included |
Pediatric: age and anesthesia plan C-7 · §III.B.1 · Not on branch: requires pediatric (under 21) | Not required on this branch | — | Not on branch |
Re-irradiation: prior course summary C-8 · §III.C.1 · Not on branch: requires prior RT to the treatment field | Not required on this branch | — | Not on branch |
Signed letter of medical necessity C-9 · §IV.1 · signature required | Letter of medical necessity Sep 17, 2026 · R. Lee, MD · p. 1 | Exact | Included |
None yet. When the audit fails a criterion, ACE searches the chart again before asking a person.
Nothing is waiting on a person. Every applicable criterion is met or resolved.