Policy Summary
This LCD (L40204) specifies that irreversible electroporation (IRE) for the management of cancer is not covered. No indications, frequency limits, or documentation requirements for coverage are provided because the policy is a non-coverage determination.
Coverage Criteria Preview
Key requirements from the full policy
"Irreversible electroporation (IRE) performed to manage any cancer is not covered (non-coverage LCD)."
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Covered Medical Codes