Aetna · Clinical coverage policy

Aetna Hyperthermia in Cancer Therapy coverage criteria

Aetna covers hyperthermia in cancer therapy only for specific indications: cytoreductive surgery plus HIPEC for mucinous carcinoma peritonei variants, peritoneal mesothelioma, and goblet cell carcinoid tumor; HIPEC with cisplatin at interval debulking for FIGO stage III ovarian cancer; regional hyperthermic melphalan perfusion for stage II, IIIA, and stage III in-transit extremity melanoma; and sequential radiation with local/regional external hyperthermia for superficial cutaneous/subcutaneous malignancies. All other applications - including deep, interstitial, intracavitary, intraluminal, and whole-body hyperthermia, and HIPEC for non-listed cancers - are considered experimental, investigational, or unproven and are not covered.

Policy CPB 0278 · Effective · Verify against the current Aetna policy before submitting — view source policy.

Payer

Aetna

Policy

CPB 0278

Prior auth

Confirm

Effective

August 28, 1998

This page reflects the coverage criteria captured from Aetna policy CPB 0278 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 Hyperthermia in Cancer Therapy (CPT 96547), and what gets it denied?

Path
Aetna covers hyperthermia in cancer therapy only for specific indications: cytoreductive surgery plus HIPEC for mucinous carcinoma peritonei variants, peritoneal mesothelioma, and goblet cell carcinoid tumor; HIPEC with cisplatin at interval debulking for FIGO stage III ovarian cancer; regional hyperthermic melphalan perfusion for stage II, IIIA, and stage III in-transit extremity melanoma; and sequential radiation with local/regional external hyperthermia for superficial cutaneous/subcutaneous malignancies. All other applications - including deep, interstitial, intracavitary, intraluminal, and whole-body hyperthermia, and HIPEC for non-listed cancers - are considered experimental, investigational, or unproven and are not covered. Coverage criteria include: Aetna considers cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) medically necessary for the treatment of (formerly called pseudomyxoma peritonei) ANY of: low-grade mucinous carcinoma peritonei (MCP-L; formerly labeled diffuse peritoneal adenomatosis [DPAM]) OR high-grade mucinous carcinoma peritonei (MCP-H; formerly labeled peritoneal mucinous carcinoma [PMCA]) OR MCP-H with signet ring cells; Aetna considers cytoreductive surgery combined with HIPEC medically necessary for the treatment of peritoneal mesothelioma; Aetna considers cytoreductive surgery combined with HIPEC medically necessary for the treatment of goblet cell carcinoid tumor; Aetna considers HIPEC medically necessary for use with cisplatin at the time of interval debulking surgery for FIGO stage III ovarian cancer; Aetna considers regional hyperthermic melphalan perfusion medically necessary in members with stage II, IIIA, AND stage III in-transit extremity melanoma (NOTE: stages I, IIIB, and IIIAB are NOT covered and are considered experimental/investigational); Aetna considers sequential radiation and local/regional external hyperthermia medically necessary ONLY for the treatment of primary or metastatic cutaneous or subcutaneous superficial malignancies (e.g., recurrent melanoma, breast cancer chest wall recurrence, head/neck lymph node metastases). Applies to 2 codes: 96547, 96548.
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: Hyperthermia is considered experimental, investigational, or unproven for all other indications (including the following) because the effectiveness of this approach in these conditions has not been established; Deep hyperthermia alone or in combination with radiation therapy - experimental/investigational/unproven; HIPEC for intrapleural mesothelioma - experimental/investigational/unproven; HIPEC for appendiceal carcinoma without mucinous carcinoma peritonei (MCP) - experimental/investigational/unproven; HIPEC for bladder cancer - experimental/investigational/unproven; HIPEC for cecal cancer - experimental/investigational/unproven; HIPEC for colon cancer - experimental/investigational/unproven; HIPEC for colorectal signet ring carcinoma - experimental/investigational/unproven; HIPEC for desmoplastic small round cell tumor - experimental/investigational/unproven; HIPEC for fallopian tube cancer - experimental/investigational/unproven; HIPEC for gastric cancer - experimental/investigational/unproven; HIPEC for hepatocellular carcinoma - experimental/investigational/unproven; HIPEC for mixed germ cell tumor - experimental/investigational/unproven; HIPEC for pancreatic cancer - experimental/investigational/unproven; HIPEC for small bowel adenocarcinoma - experimental/investigational/unproven; HIPEC for thymic carcinoma - experimental/investigational/unproven; HIPEC for urachal cancer - experimental/investigational/unproven; HIPEC for uterine leiomyosarcoma - experimental/investigational/unproven; HIPEC for peritoneal surface malignancy (peritoneal carcinomatosis, peritoneal sarcomatosis) for indications other than mucinous carcinoma peritonei (MCP) or peritoneal mesothelioma - experimental/investigational/unproven; Interstitial, intra-cavitary, and intraluminal hyperthermia - experimental/investigational/unproven; Pleural HIPEC for the treatment of metastatic pleural malignancies, pleural mesothelioma, and other indications - experimental/investigational/unproven; Prophylactic HIPEC for gastric cancer - experimental/investigational/unproven; Regional hyperthermic melphalan perfusion in stage I, IIIB, and IIIAB extremity melanoma - experimental/investigational/unproven; Regional hyperthermic perfusion for extremity melanoma in conjunction with any other chemotherapy - experimental/investigational/unproven; Regional hyperthermic perfusion for indications (e.g., non-small cell lung cancer) other than extremity melanoma - experimental/investigational/unproven; Superficial hyperthermia for paranasal sinus and nasal cavity cancer - experimental/investigational/unproven; Transrectal ultrasound hyperthermia for prostate cancer - experimental/investigational/unproven; Whole body hyperthermia for testicular cancer and other indications - experimental/investigational/unproven. Claims may be denied when the requested service falls under these.

Source: Aetna CPB 0278 — Hyperthermia in Cancer Therapy

Coverage criteria

  • Aetna considers cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) medically necessary for the treatment of (formerly called pseudomyxoma peritonei) ANY of: low-grade mucinous carcinoma peritonei (MCP-L; formerly labeled diffuse peritoneal adenomatosis [DPAM]) OR high-grade mucinous carcinoma peritonei (MCP-H; formerly labeled peritoneal mucinous carcinoma [PMCA]) OR MCP-H with signet ring cells
  • Aetna considers cytoreductive surgery combined with HIPEC medically necessary for the treatment of peritoneal mesothelioma
  • Aetna considers cytoreductive surgery combined with HIPEC medically necessary for the treatment of goblet cell carcinoid tumor
  • Aetna considers HIPEC medically necessary for use with cisplatin at the time of interval debulking surgery for FIGO stage III ovarian cancer
  • Aetna considers regional hyperthermic melphalan perfusion medically necessary in members with stage II, IIIA, AND stage III in-transit extremity melanoma (NOTE: stages I, IIIB, and IIIAB are NOT covered and are considered experimental/investigational)
  • Aetna considers sequential radiation and local/regional external hyperthermia medically necessary ONLY for the treatment of primary or metastatic cutaneous or subcutaneous superficial malignancies (e.g., recurrent melanoma, breast cancer chest wall recurrence, head/neck lymph node metastases)

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 Hyperthermia in Cancer Therapy (CPT 96547), and what gets it denied?
Aetna covers hyperthermia in cancer therapy only for specific indications: cytoreductive surgery plus HIPEC for mucinous carcinoma peritonei variants, peritoneal mesothelioma, and goblet cell carcinoid tumor; HIPEC with cisplatin at interval debulking for FIGO stage III ovarian cancer; regional hyperthermic melphalan perfusion for stage II, IIIA, and stage III in-transit extremity melanoma; and sequential radiation with local/regional external hyperthermia for superficial cutaneous/subcutaneous malignancies. All other applications - including deep, interstitial, intracavitary, intraluminal, and whole-body hyperthermia, and HIPEC for non-listed cancers - are considered experimental, investigational, or unproven and are not covered. Coverage criteria include: Aetna considers cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) medically necessary for the treatment of (formerly called pseudomyxoma peritonei) ANY of: low-grade mucinous carcinoma peritonei (MCP-L; formerly labeled diffuse peritoneal adenomatosis [DPAM]) OR high-grade mucinous carcinoma peritonei (MCP-H; formerly labeled peritoneal mucinous carcinoma [PMCA]) OR MCP-H with signet ring cells; Aetna considers cytoreductive surgery combined with HIPEC medically necessary for the treatment of peritoneal mesothelioma; Aetna considers cytoreductive surgery combined with HIPEC medically necessary for the treatment of goblet cell carcinoid tumor; Aetna considers HIPEC medically necessary for use with cisplatin at the time of interval debulking surgery for FIGO stage III ovarian cancer; Aetna considers regional hyperthermic melphalan perfusion medically necessary in members with stage II, IIIA, AND stage III in-transit extremity melanoma (NOTE: stages I, IIIB, and IIIAB are NOT covered and are considered experimental/investigational); Aetna considers sequential radiation and local/regional external hyperthermia medically necessary ONLY for the treatment of primary or metastatic cutaneous or subcutaneous superficial malignancies (e.g., recurrent melanoma, breast cancer chest wall recurrence, head/neck lymph node metastases). Applies to 2 codes: 96547, 96548. 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: Hyperthermia is considered experimental, investigational, or unproven for all other indications (including the following) because the effectiveness of this approach in these conditions has not been established; Deep hyperthermia alone or in combination with radiation therapy - experimental/investigational/unproven; HIPEC for intrapleural mesothelioma - experimental/investigational/unproven; HIPEC for appendiceal carcinoma without mucinous carcinoma peritonei (MCP) - experimental/investigational/unproven; HIPEC for bladder cancer - experimental/investigational/unproven; HIPEC for cecal cancer - experimental/investigational/unproven; HIPEC for colon cancer - experimental/investigational/unproven; HIPEC for colorectal signet ring carcinoma - experimental/investigational/unproven; HIPEC for desmoplastic small round cell tumor - experimental/investigational/unproven; HIPEC for fallopian tube cancer - experimental/investigational/unproven; HIPEC for gastric cancer - experimental/investigational/unproven; HIPEC for hepatocellular carcinoma - experimental/investigational/unproven; HIPEC for mixed germ cell tumor - experimental/investigational/unproven; HIPEC for pancreatic cancer - experimental/investigational/unproven; HIPEC for small bowel adenocarcinoma - experimental/investigational/unproven; HIPEC for thymic carcinoma - experimental/investigational/unproven; HIPEC for urachal cancer - experimental/investigational/unproven; HIPEC for uterine leiomyosarcoma - experimental/investigational/unproven; HIPEC for peritoneal surface malignancy (peritoneal carcinomatosis, peritoneal sarcomatosis) for indications other than mucinous carcinoma peritonei (MCP) or peritoneal mesothelioma - experimental/investigational/unproven; Interstitial, intra-cavitary, and intraluminal hyperthermia - experimental/investigational/unproven; Pleural HIPEC for the treatment of metastatic pleural malignancies, pleural mesothelioma, and other indications - experimental/investigational/unproven; Prophylactic HIPEC for gastric cancer - experimental/investigational/unproven; Regional hyperthermic melphalan perfusion in stage I, IIIB, and IIIAB extremity melanoma - experimental/investigational/unproven; Regional hyperthermic perfusion for extremity melanoma in conjunction with any other chemotherapy - experimental/investigational/unproven; Regional hyperthermic perfusion for indications (e.g., non-small cell lung cancer) other than extremity melanoma - experimental/investigational/unproven; Superficial hyperthermia for paranasal sinus and nasal cavity cancer - experimental/investigational/unproven; Transrectal ultrasound hyperthermia for prostate cancer - experimental/investigational/unproven; Whole body hyperthermia for testicular cancer and other indications - experimental/investigational/unproven. Claims may be denied when the requested service falls under these.
Does Aetna require prior authorization for Hyperthermia in Cancer Therapy?
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 Hyperthermia in Cancer Therapy?
Policy exclusions and limitations: Hyperthermia is considered experimental, investigational, or unproven for all other indications (including the following) because the effectiveness of this approach in these conditions has not been established; Deep hyperthermia alone or in combination with radiation therapy - experimental/investigational/unproven; HIPEC for intrapleural mesothelioma - experimental/investigational/unproven; HIPEC for appendiceal carcinoma without mucinous carcinoma peritonei (MCP) - experimental/investigational/unproven; HIPEC for bladder cancer - experimental/investigational/unproven; HIPEC for cecal cancer - experimental/investigational/unproven; HIPEC for colon cancer - experimental/investigational/unproven; HIPEC for colorectal signet ring carcinoma - experimental/investigational/unproven; HIPEC for desmoplastic small round cell tumor - experimental/investigational/unproven; HIPEC for fallopian tube cancer - experimental/investigational/unproven; HIPEC for gastric cancer - experimental/investigational/unproven; HIPEC for hepatocellular carcinoma - experimental/investigational/unproven; HIPEC for mixed germ cell tumor - experimental/investigational/unproven; HIPEC for pancreatic cancer - experimental/investigational/unproven; HIPEC for small bowel adenocarcinoma - experimental/investigational/unproven; HIPEC for thymic carcinoma - experimental/investigational/unproven; HIPEC for urachal cancer - experimental/investigational/unproven; HIPEC for uterine leiomyosarcoma - experimental/investigational/unproven; HIPEC for peritoneal surface malignancy (peritoneal carcinomatosis, peritoneal sarcomatosis) for indications other than mucinous carcinoma peritonei (MCP) or peritoneal mesothelioma - experimental/investigational/unproven; Interstitial, intra-cavitary, and intraluminal hyperthermia - experimental/investigational/unproven; Pleural HIPEC for the treatment of metastatic pleural malignancies, pleural mesothelioma, and other indications - experimental/investigational/unproven; Prophylactic HIPEC for gastric cancer - experimental/investigational/unproven; Regional hyperthermic melphalan perfusion in stage I, IIIB, and IIIAB extremity melanoma - experimental/investigational/unproven; Regional hyperthermic perfusion for extremity melanoma in conjunction with any other chemotherapy - experimental/investigational/unproven; Regional hyperthermic perfusion for indications (e.g., non-small cell lung cancer) other than extremity melanoma - experimental/investigational/unproven; Superficial hyperthermia for paranasal sinus and nasal cavity cancer - experimental/investigational/unproven; Transrectal ultrasound hyperthermia for prostate cancer - experimental/investigational/unproven; Whole body hyperthermia for testicular cancer and other indications - experimental/investigational/unproven. Claims may be denied when the requested service falls under these.

Source

Aetna CPB 0278 — Hyperthermia in Cancer Therapy

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Coverage disclaimer

This page summarizes Aetna clinical-coverage criteria extracted from policy CPB 0278 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.