96547
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
6.53
Facility
$329.67
Non-Facility
$329.67
Documentation Required
- Operative reports detailing the cytoreductive surgery, HIPEC technique (open vs closed), chemotherapeutic agent(s) used, doses, perfusate temperature(s) (inflow/outflow), perfusion duration, and intra-operative temperature monitoring logs (target intra‑abdominal/intratumoral temperatures often 41–43°C; some studies aimed for tumor temperature ≥42.5°C for specified durations).
- Intra‑operative and peri‑operative monitoring records including hemodynamics, laboratory values, transfusions, and post-operative complications (with grading), and length of hospital stay.
- Documentation of informed consent including discussion of investigational/experimental status where applicable, expected benefits, potential risks and morbidity, and alternative standard-of-care therapies.
- Evidence that treatment is being provided in a center with appropriate specialized equipment and trained personnel (documentation of center expertise, temperature monitoring capability, and post-operative care resources) when required by guideline recommendations.
Key Coverage Criteria
- CPT 96548 Intraoperative HIPEC, each additional 30 minutes — covered if selection criteria are met.
- Selected patients with peritoneal metastases from small bowel adenocarcinoma — CRS + HIPEC may offer survival benefit in highly selected patients (systematic review data).
- Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of pseudomyxoma peritonei (including disseminated peritoneal adenomucinosis (DPAM) ... as well as peritoneal mucinous carcinomatosis).
- Cytoreductive surgery combined with HIPEC for the treatment of peritoneal mesothelioma.
- Cytoreductive surgery combined with HIPEC for the treatment of goblet cell carcinoid tumor.
- HIPEC for use with cisplatin at the time of interval debulking surgery for FIGO stage III ovarian cancer.
1 Active Policy
AETNA-CPB-0278 — Hyperthermia in Cancer Therapy
Related Codes
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