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    OpenPayerPolicy UpdatesHematology/OncologyAmbetter Nevada Optune Coverage Update | OpenPayer
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    CurrentAmbetter NevadaPolicy CP.MP.145

    Electric Tumor Treating Fields (Optune)

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    Defines medical necessity and coverage criteria for tumor treating fields (TTF) therapy delivered by the Optune device for adults with supratentorial glioblastoma, including initial and continuation authorization requirements and contraindications.

    Policy Summary
    PayerAmbetter Nevada
    PolicyElectric Tumor Treating Fields (Optune)
    Policy CodePolicy CP.MP.145
    Change TypeCriteria revisions and additions (KPS threshold, age limit, device wear/compliance)
    Effective Date
    Last ReviewOct 25, 2025
    Next Review Date
    Key ActionObtain prior authorization and document patient meets KPS ≥ 60, agrees to wear device ≥18 hours/day, and meets indication criteria.
    SourceLink
    POLICY UPDATE CHANGES

    Changed Karnofsky Performance Status requirement multiple times, most recently set to ≥ 60.

    Added age restriction requiring adults > 22 years.

    Added requirement that the member agrees to wear the TTF device for 18 hours per day and, for continuation, documented compliance during prior authorization period.

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    18h/dayrequired device wear time
    ≥60KPS minimum
    90dinitial auth
    90dcontinuation auth
    supratentorialtumor location

    Coverage Criteria for Tumor Treating Fields (Optune)

    Initial Therapy (first 90 days)

    Covered when ALL of the following are met

    Initial 90 days criteria: 1) Patient is an adult > 22 years; 2) One of the following indications: a) Newly diagnosed, histologically confirmed glioblastoma AND tumor is supratentorial AND Karnofsky Performance Status ≥ 60 AND alternating electric field therapy (TTF) will be delivered in conjunction with temozolomide after standard surgical and/or radiation therapies have been completed; OR b) Recurrent glioblastoma, histologically- or radiologically-confirmed AND tumor is supratentorial AND Karnofsky Performance Status ≥ 60 AND alternating electric field therapy (TTF) will be used as monotherapy after standard treatment with chemotherapy, surgery, and/or radiation; 3) None of the following contraindications are present: implanted electronic medical device (e.g., deep brain stimulator, spinal cord stimulator, vagus nerve stimulator, pacemaker, defibrillator, programmable shunt), skull defect (missing bone without replacement) or bullet fragment, pregnancy, or known sensitivity to conductive hydrogels; 4) Member agrees to wear the TTF device for ≥ 18 hours per day.

    Continuation Therapy (additional 90 days)

    Covered when ALL of the following are met

    Continuation criteria: 1) There has been no disease progression in the most recent 90 days of TTF therapy; 2) Member agrees to wear the TTF device for ≥ 18 hours per day and demonstrated compliance with device wear during the prior authorization period.

    Other indications

    Not supported

    Insufficient evidence: There is insufficient evidence to support the use of TTF therapy for indications other than those specified (newly diagnosed or recurrent supratentorial glioblastoma).

    The policy lists specific contraindicated conditions that preclude coverage of Tumor Treating Fields (TTF) therapy. Contraindications include implanted electronic medical devices such as deep brain stimulators, spinal cord stimulators, vagus nerve stimulators, pacemakers, defibrillators, or programmable shunts. Coverage is also excluded for members with a skull defect (for example, a missing bone without replacement or the presence of a bullet fragment), for pregnancy, and for individuals with a known sensitivity to conductive hydrogels (for example, gels used with ECG stickers or TENS electrodes).

    The policy explicitly states that there is insufficient evidence to support the use of TTF therapy for any indications beyond those listed for newly diagnosed or recurrent supratentorial glioblastoma. Additionally, the policy indicates there is insufficient evidence to establish the efficacy of the NovoTal™ computer mapping software for planning TTF therapy.

    Regimens and Treatment Contexts

    RegimenIndicationCoverage status
    Optune (Tumor Treating Fields) delivered concurrently with temozolomide following completion of standard surgical and/or radiation therapies
    Newly diagnosed, histologically confirmed supratentorial glioblastoma in adults (>22 years) with Karnofsky Performance Status ≥ 60; member agrees to wear device ≥ 18 hours/day
    Covered
    RegimenIndicationCoverage status
    Optune (Tumor Treating Fields) as monotherapy after prior standard treatments (chemotherapy, surgery, and/or radiation)
    Recurrent glioblastoma, histologically- or radiologically-confirmed supratentorial tumor in adults (>22 years) with Karnofsky Performance Status ≥ 60; member agrees to wear device ≥ 18 hours/day
    Covered with criteria

    Coding and Performance Status

    Referenced HCPCSHCPCS
    A4555Electrode/transducer for use with electrical stimulation device used for cancer treatment, replacement only.
    E0766Electrical stimulation device used for cancer treatment, includes all accessories, any type
    inv-07: Karnofsky Performance Status — ≥ 60
    ThresholdKarnofsky Performance Status (KPS) ≥ 60 is required for eligibility.
    Definition contextKPS is a performance-status scale used to assess functional status; policy specifies ≥ 60 as 'good performance status'.
    Applicable settingsRequired for both initial 90-day and additional 90-day TTF therapy requests for newly diagnosed and recurrent supratentorial glioblastoma.
    Revision historyKPS requirement was revised multiple times in the policy history and most recently finalized as ≥ 60.
    inv-08: Device wear time — >= 18 hours per day
    Daily wear time>= 18 hours per day (member agrees to wear the TTF device for 18 hours/day).

    Provider Requirements, Authorization, and Documentation

    Prior Authorization

    Prior authorization required for initial and continuation TTF therapy

    Prior authorization is required for both the initial 90-day course of Tumor Treating Fields (TTF) therapy and for any additional 90-day continuation period. The policy references the device and transducer HCPCS codes for billing and authorization (E0766 for the electrical stimulation device and A4555 for electrode/transducer replacement).

    • Initial authorization: initial 90 days of TTF therapy.
    • Continuation authorization: additional 90-day periods as requested.
    • Referenced codes: E0766 (device) and A4555 (electrode/transducer replacement).
    Step Therapy

    Therapy sequencing — TTF with temozolomide for newly diagnosed GBM

    For newly diagnosed supratentorial glioblastoma, TTF must be delivered in conjunction with temozolomide after standard surgical and/or radiation therapies have been completed; for recurrent glioblastoma, TTF is used as monotherapy after standard chemotherapy, surgery, and/or radiation.

    Line of Therapy Designations

    first-line

    First-line use

    Newly diagnosed use: TTF (Optune) is used in conjunction with temozolomide after completion of standard surgical and/or radiation therapies for newly diagnosed supratentorial glioblastoma; supported by the EF-14 trial showing improved progression-free and overall survival when added to temozolomide.

    salvage

    Salvage (recurrent disease) use

    Recurrent disease use: TTF may be used as monotherapy for recurrent supratentorial glioblastoma after standard treatment with chemotherapy, surgery, and/or radiation; phase III trial data demonstrate comparable activity to chemotherapy with favorable toxicity and quality-of-life profile.

    Definitions

    inv-14: Definition of Tumor Treating Fields (TTF) / Optune — alternating electric field therapy description
    TermTumor Treating Fields (TTF) — alternating electric field therapy delivered by the Optune system.
    MechanismLow-intensity, intermediate-frequency (≈100–300 kHz; ~200 kHz for GBM) alternating electric fields applied to the brain via transducer arrays on the scalp to disrupt mitosis in dividing tumor cells.
    DeliveryFields are generated by a portable device (Optune/Optune Gio) and applied through electrodes/transducer arrays attached to the scalp.
    SelectivityTTF primarily affects dividing tumor cells and is not expected to significantly affect nondividing normal brain cells; field intensities are low and do not raise tissue temperature.
    inv-15: Karnofsky Performance Status — performance-status scale; KPS ≥ 60 defined as 'good performance status'
    Scale

    Background on Tumor Treating Fields

    Tumor Treating Fields (TTF) are an alternating electric field therapy used to treat glioblastoma by delivering low-intensity, intermediate-frequency electric fields to the scalp via transducer arrays. The policy describes TTF (Optune) as therapy that disrupts dividing tumor cells and is used as an adjunct to temozolomide in newly diagnosed supratentorial glioblastoma or as monotherapy in recurrent disease. For coverage, the policy requires clinical elements that reflect the TTF mechanism and intended use, including tumor location in the supratentorial region, adequate performance status (KPS ≥ 60), appropriate sequencing with temozolomide for newly diagnosed disease, and compliance with device wear-time requirements.

    Policy Summary
    PayerAmbetter Nevada
    PolicyElectric Tumor Treating Fields (Optune)
    Policy CodePolicy CP.MP.145
    Change TypeCriteria revisions and additions (KPS threshold, age limit, device wear/compliance)
    Effective Date
    Last ReviewOct 25, 2025
    Next Review Date
    Key ActionObtain prior authorization and document patient meets KPS ≥ 60, agrees to wear device ≥18 hours/day, and meets indication criteria.
    SourceLink
    On This Page
    Coverage Criteria for Tumor Treating Fields (Optune)Regimens and Treatment ContextsCoding and Performance StatusProvider Requirements, Authorization, and DocumentationLine of Therapy DesignationsDefinitionsBackground on Tumor Treating Fields
    Continuation requirementFor continuation (additional 90 days) the member must have been compliant with wearing the device 18 hours/day during the prior authorization period.
    DocumentationPatient agreement to wear device >=18 hours/day must be documented in the request.
    • Newly diagnosed GBM: TTF delivered with temozolomide following completion of standard surgery and/or radiation.
    • Recurrent GBM: TTF may be used as monotherapy after prior standard treatments (chemotherapy, surgery, and/or radiation).
    Documentation Required

    Required documentation to support authorization

    Submit documentation confirming glioblastoma diagnosis, tumor location, performance status, prior treatments, and patient agreement to wear the device; for continuation requests include evidence of no disease progression and documented wear-time compliance during the prior authorization period.

    • Histologic or radiologic confirmation of glioblastoma and statement that tumor is supratentorial.
    • Karnofsky Performance Status score ≥ 60.
    • Treatment history: for newly diagnosed, completion of standard surgical and/or radiation therapies and plan to deliver TTF with temozolomide; for recurrent, documentation of prior chemotherapy, surgery, and/or radiation.
    • Patient agreement to wear the TTF device ≥ 18 hours per day; for continuation, documentation of compliance during the prior authorization period and no disease progression in the last 90 days.
    Denial Risk

    Triggers for denial of TTF authorization

    Requests will be denied if the clinical criteria, performance status, device-wear agreement/compliance, or contraindications are not met or documented.

    • Indication not met: diagnosis other than newly diagnosed or recurrent supratentorial glioblastoma, or insufficient diagnostic confirmation.
    • KPS < 60.
    • No documented patient agreement to wear the device ≥ 18 hours/day or lack of compliance during prior authorization period for continuation requests.
    • Presence of contraindications: implanted electronic medical devices, skull defect without replacement or bullet fragment, pregnancy, or known sensitivity to conductive hydrogels.
    Karnofsky Performance Status (KPS) — a clinician-rated performance-status scale used to assess functional ability.
    Policy requirementThe policy requires KPS ≥ 60 to qualify as 'good performance status' for TTF eligibility.
    Use in criteriaKPS ≥ 60 is required for both newly diagnosed and recurrent supratentorial glioblastoma coverage criteria (initial and continuation requests).