Radioembolization for Primary and Metastatic Tumors of the Liver

This policy covers radioembolization—selective internal radiation therapy with yttrium‑90 microspheres (and related arterial embolization/ablative techniques)—for unresectable primary liver tumors (including hepatocellular carcinoma, e.g., as a bridge to transplant and select cases with partial portal vein thrombosis, and intrahepatic cholangiocarcinoma) and for liver‑dominant metastatic disease (eg, neuroendocrine, colorectal, melanoma, breast) in patients with adequate performance status and liver reserve. Coverage is limited to disease confined to the liver and unresectable tumors (not for resectable or widespread extrahepatic disease), generally requires ECOG 0–2 and Child‑Pugh A–B, and mandates preprocedural hepatic arterial mapping and Tc‑99m MAA SPECT to assess particle distribution and shunting; specific devices (TheraSphere, SIR‑Spheres) have narrowly defined FDA‑approved indications.

"Unresectable primary hepatocellular carcinoma (HCC) limited to the liver."