Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver Tumors

This policy covers radiofrequency ablation (RFA) of miscellaneous solid tumors (excluding liver tumors) for indications such as palliation of pain or control of osteolytic bone metastases, treatment of osteoid osteomas refractory to medical therapy, localized renal cell carcinoma ≤4 cm to preserve renal function or when surgery would substantially worsen renal function or is contraindicated, and selected primary or metastatic peripheral lung malignancies (generally ≤3 cm) in patients unfit for surgical resection or curative radiotherapy. Coverage is limited to tumors amenable to complete ablation with strict size, location, and patient-selection requirements (e.g., renal tumors ≤4 cm with documented criteria, lung lesions ≥1 cm from major mediastinal structures, no extrapulmonary metastases, and a maximum of 3 lesions per lung), and excludes liver tumors and other uses considered experimental or investigational.

"Radiofrequency ablation for osteolytic bone metastases"