C9797 — Vascular embolization or occlusion procedure with use of a pressure-generating catheter (e.g., one-way valve, intermittently occluding), inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- Each lesion measures no more than 5 cm in diameter;and
- No or minimal extra-hepatic metastases;and
- All foci of disease are amenable to ablative therapy or surgical resection.
- ââââââââââââââB.Bridge to Liver Transplantation
- CriteriaA poor candidate for surgical resection or unwilling to undergo surgical resection;andEach lesion measures no more than 5 cm in diameter;andNo or minimal extra-hepatic metastases;andAll foci of disease are amenable to ablative therapy or surgical resection.
- A.Treatment of Hepatic Tumors (Primary or Metastatic)
1 Active Policy
ANTHEM-CG-SURG-78 — CG-SURG-78 Cryosurgical, Radiofrequency, Microwave, or Percutaneous Ethanol Ablation to Treat Solid Tumors in the Liver