Ablative Treatment for Malignant Breast Tumor - (0540)

Cigna deems cryoablation, percutaneous laser ablation, microwave ablation, and radiofrequency ablation for malignant breast tumors not medically necessary and therefore not covered (examples of non‑covered codes include 19499, 0581T, 0971T). These procedures lack FDA approval for breast cancer and sufficient evidence versus standard surgery, are recommended only within clinical trials/registries by professional societies, and claims without covered codes will be denied.

"Providers should document clinical justification, relevant diagnostic imaging, pathology, and prior treatments as appropriate to support medical necessity (no specific additional documentation chec..."

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