Hyperthermic Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic Malignancies

This policy covers hyperthermic intraperitoneal chemotherapy (HIPEC) — administered intraoperatively with cytoreductive surgery or via an indwelling intraperitoneal port/catheter — for select intra‑abdominal and pelvic malignancies, notably pseudomyxoma peritonei, diffuse malignant peritoneal mesothelioma, appendiceal goblet cell adenocarcinoma without extra‑abdominal metastasis, and selected stage III epithelial ovarian/fallopian tube cancers at the time of interval cytoreduction after neoadjuvant chemotherapy. HIPEC is deemed medically necessary only when performed at the time of cytoreductive surgery and subject to strict eligibility criteria (e.g., no extra‑abdominal disease for certain tumors); CRS+HIPEC for many other indications (including peritoneal carcinomatosis from colorectal, gastric, or endometrial cancer and stage IV ovarian cancer) is considered experimental/investigational and not covered, and commonly used HIPEC drugs/devices lack FDA approval for this use.