CG-DME-44 Electric Tumor Treatment Field (TTF)

This policy addresses electric tumor treatment field (TTF) therapy devices (for example, Optune) for glioblastoma. TTF is medically necessary only when an FDA‑approved device is used for histologically confirmed supratentorial glioblastoma (WHO grade IV) and either: newly diagnosed GBM after debulking/biopsy and completed chemoradiation with temozolomide and radiotherapy without progression, used with temozolomide, with KPS ≥70 or ECOG 0–1, and the patient/caregiver trained and able to use the device on average ≥18 hours/day; or recurrent GBM when used as monotherapy. TTF is not medically necessary when these criteria are not met, for any other malignant tumors, and use of enhanced computer planning software (e.g., NovoTal) is not medically necessary in all cases.

"TTF therapy is consideredmedically necessarywhen criteria A, B and C areallmet:"

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