Archived Policies - Surgery
Radiofrequency Ablation (RFA) of Solid Tumors (Excluding Pulmonary, Renal, and Liver)
NOTE: For policy on liver tumors see SUR709.029 Radiofrequency or Cryoablation of Liver Tumors.
NOTE: For policy on pulmonary tumors see SUR706.012 Radiofrequency Ablation (RFA) of Pulmonary Tumors
NOTE: For policy on renal cell carcinoma see SUR710.017 Radiofrequency Ablation (RFA) and Cryoablation of Renal Cell Carcinoma (RCC).
Radiofrequency ablation of osteoid osteomas or bony metastases may be considered medically necessary only when determined to be indicated by the treating physician for the following:
Radiofrequency ablation may be considered medically necessary for treatment of primary and metastatic neoplasms when removal of the neoplasm may be curative but the patient has been determined by the treating physician to be unable to tolerate surgical resection.
Radiofrequency ablation is considered experimental, investigational and unproven for treatment of primary and metastatic neoplasms when the patient has been determined by the treating physician to be able to tolerate surgical resection
In radiofrequency ablation (RFA), a probe is inserted into the center of a tumor and the non-insulated electrodes, which are shaped like prongs, are projected into the tumor; heat is then generated locally by a high-frequency, alternating current that flows from the electrodes. The local heat treats the tissue adjacent to the probe, resulting in a 3 cm to 5.5 cm sphere of dead tissue. The cells killed by RFA are not removed but are gradually replaced by fibrosis and scar tissue. If there is local recurrence, it occurs at the edge and, in some cases, may be retreated. Radiofrequency ablation may be performed percutaneously, laparoscopically, or as an open procedure.
Radiofrequency ablation (RFA) is being evaluated to treat various tumors, including inoperable tumors, or to treat patients ineligible for surgery due to age, presence of comorbidities, or poor general health. Goals of RFA may include 1) controlling local tumor growth and preventing recurrence; 2) palliating symptoms; and 3) extending survival duration for patients with certain tumors. The effective volume of RFA depends on the frequency and duration of applied current, local tissue characteristics, and probe configuration (e.g., single vs. multiple tips).
Potential complications associated with RFA include those caused by heat damage to normal tissue adjacent to the tumor (e.g., intestinal damage during RFA of kidney), structural damage along the probe track (e.g., pneumothorax as a consequence of procedures on the lung), or secondary tumors if cells seed during probe removal.
RFA was initially developed to treat inoperable tumors of the liver. Recently, reports have been published on use of RFA to treat renal cell carcinomas, breast tumors, pulmonary cancers (including primary and metastatic lung tumors), bone, and other tumors. For some of these, RFA is being investigated as an alternative to surgery for operable tumors. Well-established local or systemic treatment alternatives are available for each of these malignancies. The hypothesized advantages of RFA for these cancers include improved local control and those common to any minimally invasive procedure (e.g., preserving normal organ tissue, decreasing morbidity, decreasing length of hospitalization).
Breast tumors. There has been a trend in the treatment of small breast cancers from total mastectomy toward increasingly more conservative treatment options such as lumpectomy, with more acceptable cosmetic outcomes and preservation of the breast. The selection of surgical approach balances the patient’s desire for breast conservation and the need for tumor-free margins in resected tissue. Minimally invasive nonsurgical techniques such as RFA are appealing if they can produce local control and survival equivalent to breast-conserving surgical alternatives. Nonsurgical ablative techniques pose difficulties such as the inability to determine tumor size, complete tumor cell killing, and local recurrence. Additionally, RFA can cause burning of the skin or damage to muscle, possibly limiting use in patients with tumors near the skin or chest wall. (1)
Head and neck cancer. In patients with head and neck cancer with recurrent disease, surgical salvage attempts are poor in terms of local control, survival, and quality of life, and these recurrent tumors are often untreatable with standard salvage therapies. (2) Palliative chemotherapy or comfort measures may be offered. The safety and efficacy of RFA has been investigated as an option for palliative treatment in these situations.
Osteoid osteomas. Osteomas are the most common benign bone tumor, comprising 10–20% of benign and 2–3% of all bone tumors. (3) They are typically seen in children and young adults, with most diagnosed in patients between 5–20 years of age. Osteomas are most common in the lower extremity (usually the long bones, mainly the femur) and less common in the spine. These tumors typically have a characteristic clinical presentation and radiologic appearance, with pain, usually continuous and worse at night, and usually relieved by aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). The natural history of the osteoid osteoma varies based upon its location, and although they rarely exceed 1.5 cm, may produce bone widening and deformation, limb length inequality, or angular deviations when near a growth plate. (3) When located in the spine, these lesions may lead to painful scoliosis or torticollis. (4) Sometimes, they heal spontaneously after 3–7 years.
Treatment options include medical management with NSAIDs, surgical excision (wide/en bloc excision or curetting), or the use of CT- or magnetic resonance imaging (MRI)-guided minimally invasive procedures including core drill excision, laser photocoagulation, or RFA. For many years, complete surgical excision was the classic treatment of osteomas, usually performed in patients with pain despite medical management. Complete surgical excision has several disadvantages. A substantial incision may be necessary and removal of a considerable amount of bone (especially in the neck of the femur), increases the need for bone grafting and/or internal fixation (which often necessitates a second procedure to remove the metal work). Other possible risks include avascular necrosis of the femoral head and postoperative pathologic fracture. In addition, surgical excision leads to a lengthier period of convalescence and postoperative immobilization. Anatomically inaccessible tumors may not be completely resectable and may recur. RFA of osteoid osteoma is done with a needle puncture, so no incision or sutures are needed, and patients may immediately walk on the treated extremity and return to daily activities as soon as the anesthetic effect wears off. (4) The risk of recurrence with RFA of an osteoma is 5–10%, and recurrent tumors can be retreated with RFA. (4) In general, RFA is not performed in many spinal osteomas because of possible thermal-related nerve damage.
Palliation for bone metastases. After lung and liver, bone is the third most common metastatic site and is relatively frequent among patients with primary malignancies of the breast, prostate, and lung. Bone metastases often cause osteolysis (bone breakdown), resulting in pain, fractures, decreased mobility, and reduced quality of life. External-beam irradiation often is the initial palliative therapy for osteolytic bone metastases. However, pain from bone metastases is refractory to radiation therapy in 20–30% of patients, while recurrent pain at previously irradiated sites may be ineligible for additional radiation due to risks of normal tissue damage. Other alternatives include hormonal therapy, radiopharmaceuticals such as strontium 89, and bisphosphonates. Less often, surgery or chemotherapy may be used for palliation, and intractable pain may require opioid medications. RFA has been investigated as another alternative for palliating pain from bone metastases.
Thyroid tumors. Surgical resection is the primary treatment choice for medically unresponsive, symptomatic benign thyroid tumors and thyroid carcinomas. However, techniques for ablation of thyroid tumors (e.g., RFA and microwave ablation) are being investigated.
The U.S. Food and Drug Administration (FDA) issued a statement September 24, 2008 concerning the regulatory status of radiofrequency ablation. The FDA has cleared RFA devices for the general indication of soft tissue cutting, coagulation, and ablation by thermal coagulation necrosis. Under this general indication, RFA can be used as a tool to ablate tumors. Some RFA devices have been cleared for additional specific treatment indications, including partial or complete ablation of nonresectable liver lesions and palliation of pain associated with metastatic lesions involving bone.
In 2010, Zhao and Wu conducted a systematic review of 38 studies on ablation techniques for breast cancer treatment published from 1994 to 2009. (5) Nine of the studies reviewed focused on RFA. The RFA studies included small breast tumors ranging in size from 0.5–7 cm. Tumor resection was performed immediately after ablation or up to 4 weeks after RFA. Complete coagulation necrosis rates of 76% to 100% were reported. The authors concluded RFA for breast cancer tumors is feasible, but further studies with longer follow-up on survival, tumor recurrence, and cosmetic outcomes are needed. In another 2010 review, Soukup and colleagues examined 17 studies on RFA for the treatment of breast tumors and found RFA is feasible and promising. However, while minimal adverse effects and complications occurred with breast RFA, the authors noted incomplete tumor ablation remains a concern. (6)
The following are examples of published studies on RFA for breast tumors. In 2012, Wilson and colleagues reported on 73 patients with invasive breast cancer who had a lumpectomy followed immediately by RFA to the lumpectomy bed. (7) The average breast tumor size was 1.0 + 0.54 cm (range 0.2-2.6 cm) and follow-up averaged 51 months. Disease-free survival was 100%, 92% and 86% at 1-, 3- and 5-years, respectively. One patient had tumor recurrence within 5 cm of the lumpectomy site and 3 patients had ipsilateral breast recurrences. In 2009, Imoto et al. reported on a series of 30 patients with T1N0 breast cancer who had sentinel node biopsy followed by RFA and breast-conserving surgery. (8) Twenty-six patients showed pathologic degenerative changes in tumor specimens with hematoxylin-eosin staining, and, in 24 of 26 cases, tumor cell viability was diagnosed as negative by nicotinamide adenine dinucleotide diaphorase staining. Two patients had skin burns and 7 had muscle burn related to RFA. In a 2008 2-stage Phase II clinical trial, patients with histologically confirmed noninflammatory and 3 cm or less ipsilateral breast tumor recurrence were treated with RFA followed by mastectomy. The study was ended early because of insufficient efficacy of the technique tested. (9) Authors of a small (n=10) series, in 2009, in which tumor size and fat content were analyzed, concluded that “the fat content of small primary breast cancer could serve as a ‘heat sink’ and should be considered as a preventing factor of complete local tumor destruction by RF thermal ablation.” (10) In a 2011 Phase I/II study, 49 patients were treated with RFA for breast tumors (mean size 1.70 cm) followed immediately with surgical resection. (11) Complete ablation was achieved in 30 patients (61%) by H&E staining and/or NADH diaphorase staining. Complete ablation increased to 83% in 24 patients with tumor size equal to or less than 2 cm in diameter. Adverse events related to the procedure included 3 muscle burns and 2 skin burns.
Studies on RFA for breast tumors have reported varied and incomplete ablation rates with concerns about post-ablation tumor cell viability. Long-term improvements in health outcomes have not been demonstrated. Additionally, available studies do not allow comparisons to conventional breast-conserving procedures. Further studies, with long-term follow-up, are needed to determine whether RFA for small breast cancers can provide local control and survival rates comparable to conventional breast-conserving treatment.
National Comprehensive Cancer Network (NCCN) Guidelines
NCCN guidelines do not address RFA in the management of breast cancer.
National Cancer Institute Clinical (NCI) Trials Database (PDQ®)
A search of the clinical trials database online at ClinicalTrials.gov identified no randomized studies on RFA for breast cancer. One non-randomized study will evaluate outcomes of RFA after breast cancer lumpectomy in 250 patients (NCT01153035) Two other ongoing Phase I/II NCI clinical trials were identified, including a pilot study of RFA to breast cancer lumpectomy sites to achieve negative margins without removing large volumes of tissue (NCT00571987) and a study of RFA after single-insertion image-guided vacuum-assisted biopsy to achieve negative margins in small breast cancers (<1.5 cm) (NCT00574301).
Head and Neck Cancer
A case series showed palliative CT-guided RFA provided subjective improvement with regard to pain, appearance, and function in 12 patients who had recurrent and advanced head and neck malignancies and were not candidates for radiation or surgery. (12) The procedure was deemed reasonably safe and feasible for this indication, but further study is needed.
A case series of RFA for 14 patients with recurrent advanced head and neck malignancies was reported by Brook et al. (2) Tumor targeting and electrode deployment was successful in all cases, and 4 of 6 patients who completed quality-of-life assessments showed improvement. Three major complications (in 27 applications, 11%) occurred 7 days to 2 weeks after the procedure. These included stroke, carotid artery rupture leading to death, and threatened carotid artery rupture with subsequent stroke. Retrospective analysis of intraprocedural CT scans revealed that the retractable electrodes were within 1 cm of the carotid artery during ablation in these cases.
In 2011, Owen et al. reported on RFA for 13 patients with recurrent and/or unresectable head and neck cancer who failed curative treatment. (13) Median patient survival was 127 days. While stable disease was reported in 8 patients after RFA, and quality-of-life scores improved, 3 deaths occurred (1 carotid hemorrhage and 2 strokes).
The evidence for RFA in head and neck tumors is limited to small case series. While RFA may have a role in palliation, complications are common and severe.
National Comprehensive Cancer Network (NCCN) Guidelines
NCCN guidelines do not address the use of RFA in head and neck cancer.
National Cancer Institute Clinical Trials Database (PDQ®)
A search of the NCI clinical trial database at ClinicalTrials.gov returned no current trials on the use of RFA in head and neck cancer.
In 2011, Rimondi and colleagues reported on a retrospective study of 557 patients treated with computed tomography (CT)-guided RFA as primary treatment for non-spinal osteoid osteomas. (14) All patients were followed for a mean of 3.5 years (0.5-9 years). Pain relief occurred in all 557 patients within the first week after RFA and continued in 533 patients (96%) who remained asymptomatic through their last follow-up. Pain recurrence occurred in 24 patients (4%). Complications occurred in 5 patients and included thrombophlebitis, a skin burn, a broken electrode and 2 procedures in which the RFA generator didn’t reach maximum temperature.
In 2003, Rosenthal and colleagues reported their experience over an 11-year period with 271 RFA procedures for osteoid osteomas in 263 patients. (15) Short-term outcome was evaluated to detect procedure-related problems; by this definition, all procedures were considered technically successful. Long-term clinical success data (defined as being free of pain without the necessity of additional procedures) were available in 126 patients, with a complete clinical success observed in 89%. For procedures performed as the initial treatment, the success rate was 91%.
In 2004, Cioni and colleagues reported on a case series of 38 patients with osteoid osteoma diagnosed clinically, as well as by radiography, scintigraphy, contrast-enhanced magnetic resonance imaging (MRI), and CT. A total of 30 of the 38 patients reported prompt pain relief. Six of the remaining 8 patients underwent successful retreatment, and 2 underwent surgical excision. (16)
Another case series reported primary success in 37 of 38 (97%) patients (age range: 5–43 years) who underwent CT-guided percutaneous RFA to treat clinically and radiologically suspected osteoid osteoma. (17) Lesions were located in the proximal femur (n=13), tibia (n=5), foot (n=5), spine and fibula (n=3 each), acetabulum and humerus (n=2 each), and in other sites (n=5). All patients experienced sufficient pain relief to permit resumption of normal activities within 24 hours of the procedure. During follow-up, ranging from 3–24 months, no major complications were reported.
While there are no randomized trials for this indication, uncontrolled studies have demonstrated RFA can provide adequate pain relief with minimal complications. Therefore, the use of RFA for the treatment of osteoid osteomas that cannot be successfully treated with medical treatment may be considered medically necessary.
National Institute for Clinical Excellence (NICE)
Guidance issued in 2004 indicates that “current evidence on the safety and efficacy of computed tomography (CT)-guided thermocoagulation of osteoid osteoma appears adequate to support its use, provided that the normal arrangements are in place for consent, audit and clinical governance.” (18)
Palliation of Pain from Bone Metastases
Goetz et al. (19) reported on an international study (n=43) conducted at 9 centers in which patients with painful osteolytic bone metastases were treated palliatively with radiofrequency ablation (RFA). The study’s primary outcome measure was the Brief Pain Inventory-Short Form, a validated scale from 0 for no pain to 10 for worst pain imaginable. Patient eligibility required baseline values of 4 or more from 2 or fewer painful sites. Thirty-nine (91%) of the patients had previously received opioids to control pain from the lesion(s) treated with RFA, and 32 (74%) had prior radiation therapy to the same lesion. Mean pain score at baseline was 7.9 (range: 4–10). At 4, 12, and 24 weeks after RFA, average pain scores decreased to 4.5, 3.0, and 1.4, respectively (all p<0.0005). Forty-one (95%) of the patients achieved a clinically significant improvement in pain scores, prospectively defined as a decrease of 2 units from baseline. Investigators also reported statistically significant (p=0.01) decreases in opioid use at weeks 8 (by 59%) and 12 (by 54%).
An earlier case series showed that palliative RFA provided significant pain relief in 9 of 10 (90%) patients with unresectable, osteolytic spine metastases who had no other treatment options. (20) Pain was reduced by an average of 74%; back pain-related disability was reduced by an average of 27%. Neurologic function was preserved in 9 patients and improved in 1. An additional small case series of 24 patients with painful metastatic bone tumors who experienced pain-alleviating effects with RFA supports the policy statement. (21)
Several additional case series reports have been published with similar conclusions. These uncontrolled studies included only a limited number of cases. However, the patient populations comprised individuals with limited or no treatment options, for whom short-term pain relief is an appropriate outcome. Therefore, the use of RFA as palliative therapy in patients with painful metastatic bone lesions may be considered medically necessary.
Because data were unavailable on use of RFA as initial therapy for pain from bone metastases, this indication remains investigational. Neither setting is addressed in the National Comprehensive Cancer Network (NCCN) guidelines for the treatment of bone cancers.
A case series of 94 elderly subjects with solid or mainly solid benign thyroid nodules was reported by an Italian center. (22) Thyroid nodule volume, compressive symptoms, and thyroid function were evaluated at baseline and 12 to 24 months after treatment. All thyroid nodules significantly decreased in size after RFA. Compressive symptoms improved in all patients and disappeared completely in 88% of patients. Hyperthyroidism resolved in most patients allowing methimazole therapy to be completely withdrawn in 79% of patients with pretoxic and toxic thyroid nodules (100% in pretoxic and 53% with toxic thyroid nodules). The authors observe that RFA is particularly attractive for elderly people for whom surgery and radioiodine therapy are often contraindicated or ineffective. A smaller series (n=33) also from Italy found similar outcomes in terms of reduction in compressive symptoms and improvement in thyroid function. (23) Hyperfunction was fully controlled in 24% of patients and partially reduced in the others.
In 2012, Huh and colleagues reported on 30 patients randomized to receive either 1 or 2 RFA sessions for the treatment of benign thyroid nodules. Significant volume reduction occurred in each group of 15 patients after RFA. (24) A single session of RFA was sufficient to reduce tumor volume and improve clinical symptoms in 12 patients (80%). Only 3 patients with nodules larger than 20 mL required an additional session of RFA. Baek et al. reported on a retrospective review of RFA for 1,543 benign thyroid nodules in 1,459 patients at 13 thyroid centers. (25) Forty-eight (3.3%) complications occurred and included 20 major complications: voice changes (n=15), brachial plexus injury (n=1), tumor rupture (n=3), and permanent hypothyroidism (n=1). Twenty-eight minor complications included: hematoma (n=15), skin burn (n=4), and vomiting (n=9). One patient experienced permanent hypothyroidism while another required surgery.
In 2012, the Korean Society of Thyroid Radiology (KSTR) developed consensus recommendations for RFA of thyroid tumors after a review of the literature found few controlled studies. (26) The KSTR recommendations indicate RFA may be appropriate for the treatment of benign thyroid nodules, inoperable thyroid nodules, and recurrent thyroid cancers in the operation bed and lymph nodes. The KSTR recommendations also indicate RFA should not be used for primary thyroid cancers or follicular neoplasms citing no evidence of treatment benefit.
The evidence for RFA in thyroid tumors is primarily limited to case series and uncontrolled studies. While RFA has been shown to reduce thyroid tumor volume and improve clinical symptoms, complications can be common and available evidence is insufficient to determine the impact of RFA on net health outcomes.
National Cancer Institute Clinical Trials Database (PDQ®)
A search of the National Cancer Institute (NCI) clinical trial database online at ClinicalTrials.gov returned no current trials on the use of RFA in thyroid tumors.
National Comprehensive Cancer Network (NCCN) Guidelines
NCCN guidelines for thyroid carcinoma indicate ablation techniques such as radiofrequency may be considered for palliative resection of symptomatic distant metastases that are causing symptoms (e.g., those in bone). (27) Ablation may also be considered for asymptomatic distant metastases when there is progressive disease, but observation is acceptable, given the lack of data regarding alteration in outcome.
One case series of 13 patients with adrenal neoplasms treated with RF ablation was identified. Eleven of the 13 lesions were treated successfully with RFA, defined by follow-up CT scans and normalization of preprocedural biochemical abnormalities. (28)
A single-arm, retrospective, paired-comparison study evaluated the short-term efficacy of RFA in relationship to pain and functional impact in patients with unresectable, painful soft tissue neoplasms recalcitrant to conventional therapies. (29) Patients had tumors located in a variety of sites including chest wall, pelvis, breast, perirectal, renal, aortocaval, retroperitoneal, and superficial soft tissues. All had exhausted conventional methods of palliation or experienced dose-limiting adverse effects from pain medication. Although not all Brief Pain Inventory scores were statistically significant, all mean scores trended down with increased time after ablation. Complications from RFA were minor or insignificant in all but 1 patient who had skin breakdown and infection of the ablated superficial tumor site.
Additional articles address the use of RFA in solid malignancies (4, 30) and in the pancreas. (31-33)
Preliminary results of endoscopic RFA of rectosigmoid tumors have been described in a paper by Vavra et al. Twelve patients were treated with the Endoblate RFA device, with 10 patients having surgical resection after ablation. (34) Histology of the resected specimens showed that, on average, 82% (range: 60-99%) of the tumor mass was destroyed in the ablation zone.
Stereotactic radiofrequency thermocoagulation for epileptogenic hypothalamic hamartomas is described in a retrospective analysis of a series of 25 patients with gelastic seizures (a rare type of seizure that involves a sudden burst of energy, usually in the form of laughing or crying). (35) Other seizure types were exhibited in 22 patients (88.0%), precocious puberty in 8 (32.0%), behavioral disorder in 10 (40.0%), and mental retardation/intellectual disability in 14 (56.0%). Gelastic seizures resolved in all but 2 patients. Complete seizure freedom was achieved in 19 patients (76.0%). These patients had disappearance of all seizure types and behavioral disorder and also demonstrated intellectual improvement.
Small case series on RFA for colorectal and rectal carcinoma have demonstrated a debulking role for RFA. (36, 37)
These case series do not allow comparison with available alternative treatments and further study is required.
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The following codes may be applicable to this Medical policy and may not be all inclusive.
ICD-9 Diagnosis Codes
213.0, 213.1, 213.2, 213.3, 213.4, 213.5, 213.6, 213.7, 213.8, 213.9, 174.0, 174.1, 174.2, 174.3, 174.4, 174.5, 174.6, 174.8, 174.9, 195.0, 215.0
ICD-9 Procedure Codes
ICD-10 Diagnosis Codes
C50.011-C50.929, C76.0, C79.51, C79.52, D16.00-D16.9
ICD-10 Procedure Codes
0HBT0ZZ, 0HBT3ZZ, 0HBT7ZZ, 0HBT8ZZ, 0HBTXZZ, 0HBU0ZZ, 0HBU3ZZ, 0HBU7ZZ, 0HBU8ZZ, 0HBUXZZ, 0HBY0ZZ, 0HBY3ZZ, 0HBY7ZZ, 0HBY8ZZ, 0HBYXZZ, 0P500ZZ, 0P503ZZ, 0P504ZZ, 0P510ZZ, 0P513ZZ, 0P514ZZ, 0P520ZZ, 0P523ZZ, 0P524ZZ, 0P550ZZ, 0P553ZZ, 0P554ZZ, 0P560ZZ, 0P563ZZ, 0P564ZZ, 0P570ZZ, 0P573ZZ, 0P574ZZ, 0P580ZZ, 0P583ZZ, 0P584ZZ, 0P590ZZ, 0P593ZZ, 0P594ZZ, 0P5B0ZZ, 0P5B3ZZ, 0P5B4ZZ, 0P5C0ZZ, 0P5C3ZZ, 0P5C4ZZ, 0P5D0ZZ, 0P5D3ZZ, 0P5D4ZZ, 0P5F0ZZ, 0P5F3ZZ, 0P5F4ZZ, 0P5G0ZZ, 0P5G3ZZ, 0P5G4ZZ, 0P5H0ZZ, 0P5H3ZZ, 0P5H4ZZ, 0P5J0ZZ, 0P5J3ZZ, 0P5J4ZZ, 0P5K0ZZ, 0P5K3ZZ, 0P5K4ZZ, 0P5L0ZZ, 0P5L3ZZ, 0P5L4ZZ, 0P5M0ZZ, 0P5M3ZZ, 0P5M4ZZ, 0P5N0ZZ, 0P5N3ZZ, 0P5N4ZZ, 0P5P0ZZ, 0P5P3ZZ, 0P5P4ZZ, 0P5Q0ZZ, 0P5Q3ZZ, 0P5Q4ZZ, 0P530ZZ, 0P533ZZ, 0P534ZZ, 0P540ZZ, 0P543ZZ, 0P544ZZ, 0P5R0ZZ, 0P5R3ZZ, 0P5R4ZZ, 0P5S0ZZ, 0P5S3ZZ, 0P5S4ZZ, 0P5T0ZZ, 0P5T3ZZ, 0P5T4ZZ, 0P5V0ZZ, 0P5V3ZZ, 0P5V4ZZ, 0Q560ZZ, 0Q563ZZ, 0Q564ZZ, 0Q570ZZ, 0Q573ZZ, 0Q574ZZ, 0Q580ZZ, 0Q583ZZ, 0Q584ZZ, 0Q590ZZ, 0Q593ZZ, 0Q594ZZ, 0Q5B0ZZ, 0Q5B3ZZ, 0Q5B4ZZ, 0Q5C0ZZ, 0Q5C3ZZ, 0Q5C4ZZ, 0Q5D0ZZ, 0Q5D3ZZ, 0Q5D4ZZ, 0Q5F0ZZ, 0Q5F3ZZ, 0Q5F4ZZ, 0Q5G0ZZ, 0Q5G3ZZ, 0Q5G4ZZ, 0Q5H0ZZ, 0Q5H3ZZ, 0Q5H4ZZ, 0Q5J0ZZ, 0Q5J3ZZ, 0Q5J4ZZ, 0Q5K0ZZ, 0Q5K3ZZ, 0Q5K4ZZ, 0Q5L0ZZ, 0Q5L3ZZ, 0Q5L4ZZ, 0Q5M0ZZ, 0Q5M3ZZ, 0Q5M4ZZ, 0Q5N0ZZ, 0Q5N3ZZ, 0Q5N4ZZ, 0Q5P0ZZ, 0Q5P3ZZ, 0Q5P4ZZ, 0Q500ZZ, 0Q503ZZ, 0Q504ZZ, 0Q510ZZ, 0Q513ZZ, 0Q514ZZ, 0Q520ZZ, 0Q523ZZ, 0Q524ZZ, 0Q530ZZ, 0Q533ZZ, 0Q534ZZ, 0Q540ZZ, 0Q543ZZ, 0Q544ZZ, 0Q550ZZ, 0Q553ZZ, 0Q554ZZ, 0Q5Q0ZZ, 0Q5Q3ZZ, 0Q5Q4ZZ, 0Q5R0ZZ, 0Q5R3ZZ, 0Q5R4ZZ, 0Q5S0ZZ, 0Q5S3ZZ, 0Q5S4ZZ
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The Centers for Medicare and Medicaid Services (CMS) does not have a national Medicare coverage position. Coverage may be subject to local carrier discretion.
A national coverage position for Medicare may have been developed since this medical policy document was written. See Medicare's National Coverage at <http://www.cms.hhs.gov.
5/15/2013 Document updated with literature review. In Coverage, the following statement: “Radiofrequency ablation is considered experimental, investigational and unproven for initial treatment of any other tumors” was replaced with: “Radiofrequency ablation is considered experimental, investigational and unproven for treatment of primary and metastatic neoplasms when the patient has been determined by the treating physician to be able to tolerate surgical resection.”
6/15/2011 Document updated with literature review. Coverage unchanged.
8/15/2009 Routine update with literature review and no change in coverage
8/15/2007 New medical document
|Title:||Effective Date:||End Date:|
|Radiofrequency Ablation (RFA) of Solid Tumors, Excluding Liver||04-15-2017||06-30-2018|
|Radiofrequency Ablation (RFA) of Solid Tumors, Excluding Liver||08-01-2016||04-14-2017|
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|Radiofrequency Ablation (RFA) of Pulmonary Tumors||06-01-2013||06-30-2014|
|Radiofrequency Ablation (RFA) of Solid Tumors (Excluding Pulmonary, Renal, and Liver)||05-15-2013||06-30-2014|
|Radiofrequency Ablation (RFA) of Solid Tumors (Excluding Pulmonary, Renal, and Liver)||06-15-2011||05-14-2013|
|Radiofrequency Ablation (RFA) of Solid Tumors (Excluding Pulmonary, Renal, and Liver)||08-15-2009||06-14-2011|
|Radiofrequency Ablation (RFA) of Solid Tumors (Excluding Pulmonary, Renal, and Liver)||08-15-2007||08-14-2009|