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| Section: |
Radiation Therapy & Nuclear Medicine |
| Number: |
R-2 |
| Topic: |
Hyperthermia in Conjunction with Radiation Therapy for Treatment of Cancer |
| Effective Date: |
March 13, 2006 |
| Issued Date: |
July 14, 2008 |
| Date Last Reviewed: |
03/2006 |
General Policy Guidelines
Indications and Limitations of Coverage
Hyperthermia is effective when used as an adjunct to radiation therapy. Externally generated regional hyperthermia and interstitial and intracavitary hyperthermia are recognized as eligible services only when used in conjunction with radiation therapy for the treatment of malignant tumors. Hyperthermia is eligible under codes 77600-77620.
Although hyperthermia itself is recognized as a distinct eligible service, a single charge for treatment planning for both the radiation therapy and hyperthermia treatment should be reported under codes 77261-77263 as appropriate.
Hyperthermia is not medically necessary when when used alone or in connection with chemotherapy, and is therefore not eligible for coverage.
Description
Hyperthermia for treatment of cancer consists of the use of heat to make tumors more susceptible to cancer therapy measures. It may be induced by a variety of sources, e.g., microwave, ultrasound, low energy radiofrequency conduction, or by probes. |
- NOTE:
- This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.
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Procedure Codes
| 77261 | 77262 | 77263 | 77600 | 77605 | 77610 |
| 77615 | | | | | |
Traditional Guidelines
FEP Guidelines
PPO Guidelines
Managed Care POS Guidelines
Publications
References
View Previous Versions
Table Attachment
Text Attachment
Procedure Code Attachment
Glossary
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This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.
Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.
Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Mountain State Blue Cross Blue Shield plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.
Mountain State Blue Cross Blue Shield (MSBCBS) retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of MSBCBS. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.
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