Q0083, Chemotherapy administration by other than infusion technique only (e.g.,
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Coverage determinations must include review of the member's benefit contract/SPD for coverage, exclusions, and limitations.
- Procedure codes listed in the policy are provided only as a general reference and may not be all-inclusive.
- Presence or absence of codes in the policy does not determine coverage or reimbursement; only the written coverage position governs determinations.
Key Coverage Criteria
- TACE is medically necessary to treat unresectable, confined-to-liver hepatocellular carcinoma without portal vein thrombosis and without Child-Pugh C (i.e., Child-Pugh class A or B). It may also be used as a bridge to liver transplant in hepatocellular carcinoma to prevent tumor growth and maintain transplant candidacy; or to treat liver metastases in symptomatic metastatic neuroendocrine tumor not candidate for surgery; or liver-dominant metastatic uveal melanoma.
- Transcatheter arterial chemoembolization of the liver is medically necessary to treat unresectable hepatocellular carcinoma confined to the liver (no portal vein thrombosis, Child-Pugh class A/B). It may also be used as a bridge to liver transplant, to treat liver metastases from metastatic neuroendocrine tumors not responding to systemic therapy or from liver-dominant metastatic uveal melanoma.
- Medically necessary to treat unresectable hepatocellular carcinoma confined to the liver without portal vein thrombosis and with liver function not characterized as Child-Pugh class C.
- Medically necessary as a bridge to transplant to prevent further tumor growth and to maintain transplant candidacy in individuals with hepatocellular cancer.
- For bridge-to-transplant use, candidate selection should include: single tumor <5 cm or ≤3 tumors each <3 cm; absence of extrahepatic disease or vascular invasion; Child-Pugh class A or B.
- Medically necessary to treat liver metastases in symptomatic individuals with metastatic neuroendocrine tumor whose symptoms persist despite systemic therapy and who are not surgical candidates.
4 Active Policies
BCBSIL-THE801.022, Transcatheter Arterial Chemoembolization to Treat Primary or Metastatic Liver Malignancies
BCBSMT-THE801.022, Transcatheter Arterial Chemoembolization to Treat Primary or Metastatic Liver Malignancies
BCBSNM-THE801.022, Transcatheter Arterial Chemoembolization to Treat Primary or Metastatic Liver Malignancies
BCBSOK-THE801.022, Transcatheter Arterial Chemoembolization to Treat Primary or Metastatic Liver Malignancies
Related Codes
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