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    v1.0.31
    OpenPayerPolicy UpdatesHematology/OncologyAmeriHealth VIP Tumor Fields Coverage | OpenPayer
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    CurrentAmeriHealth Caritas VIP CarePolicy CCP.1568

    Tumor Treating Fields for Pancreatic Cancer

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    This policy governs coverage determinations for tumor treating fields therapy, including alternating electric field devices, used to treat pancreatic cancer. It applies to providers submitting claims for this service under AmeriHealth Caritas VIP Care and considers plan benefits, applicable law, and individual clinical circumstances.

    Policy Summary
    PayerAmeriHealth Caritas VIP Care
    PolicyTumor Treating Fields for Pancreatic Cancer
    Policy CodePolicy CCP.1568
    Change TypeNo material change
    Effective DateSeptember 1, 2026
    Last ReviewAug 1, 2026
    Next Review DateDecember 1, 2027
    Key ActionClaims for tumor treating fields used for unresectable, locally advanced pancreatic cancer may be denied.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    Not coveredCoverage stance
    571

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    PANOVA-3 participants
    150 kHzTreatment frequency
    76.3%Skin adverse events
    2.352 monthsMean survival gain

    Coverage Criteria

    Tumor Treating Fields for Locally Advanced Pancreatic Cancer

    Tumor treating fields for treatment of unresectable, locally advanced pancreatic cancer are not covered.

    Tumor treating fields for treatment of unresectable, locally advanced pancreatic cancer are investigational/not clinically proven and, therefore, not medically necessary.

    For determinations of medical necessity for medications, refer to the applicable state-approved pharmacy policy.

    The U.S. Food and Drug Administration (2026) approved Optune Pax for the treatment of adult patients with locally advanced pancreatic cancer, concomitant with gemcitabine and nab-paclitaxel. Optune Pax is contraindicated in patients with an electrical implant or sensitivity to the gels used for adhesion.

    Tumor treating fields for treatment of unresectable, locally advanced pancreatic cancer are investigational, not clinically proven, and therefore not medically necessary.

    Related Codes

    Related codesCPT
    1025TAlternating electric fields dosimetry and delivery-simulation modeling, creation and selection of patient-specific array layouts, and placement verification
    Related codesHCPCS
    A4555Electrode/transducer for use with electrical stimulation device used for cancer treatment, replacement only
    Related codesHCPCS
    E0766Electrical stimulation device used for cancer treatment, includes all accessories, any type

    Provider and Coverage Actions

    Denial Risk

    Claims may be denied as investigational

    Do not submit tumor treating fields therapy for the treatment of unresectable, locally advanced pancreatic cancer as a covered service. The therapy is investigational, not clinically proven, and therefore not medically necessary; claims may be denied.

    Clinical Background

    Pancreatic adenocarcinoma arises from pancreatic duct cells and is the most common type of pancreatic cancer. Locally advanced disease has extended locally such that surgical resection is not possible.

    Tumor treating fields, also called alternating electric fields, are low-energy, non-ionizing electrical fields intended to disrupt cancer-cell growth and division. Optune Pax is a portable, wearable device that delivers fields at 150 kHz to the abdomen through noninvasive, electrically insulated transducer arrays. It was studied with gemcitabine and nab-paclitaxel as first-line treatment for unresectable, locally advanced pancreatic adenocarcinoma; the available evidence includes the manufacturer-sponsored PANOVA-3 trial and reported frequent device-related skin adverse events.

    Key Definitions

    Tumor treating fields
    DefinitionLow-energy, non-ionizing electrical fields that disrupt cancer cells’ ability to grow and divide.
    Optune Pax
    DevicePortable, wearable device that delivers tumor treating fields to the abdomen through non-invasive, electrically insulated transducer arrays.
    Treatment frequency150 kHz
    Locally advanced pancreatic cancer
    DefinitionPancreatic cancer with local extension that prevents surgical resection.

    Line of Therapy

    First-Line Therapy

    The applicable line-of-therapy criterion is:

    Front-line therapy: Tumor treating fields are used in combination with gemcitabine and nab-paclitaxel as front-line treatment for unresectable, locally advanced pancreatic adenocarcinoma.

    Although this was the studied line of therapy, the tumor treating fields service is not covered under this policy.

    Treatment Regimens

    RegimenApplicable populationCoverage
    Tumor treating fields in combination with gemcitabine and nab-paclitaxelAdults with unresectable, locally advanced pancreatic adenocarcinoma; studied as front-line treatmentNot covered
    Treatment optionApplicable populationCoverage
    Guideline-directed systemic therapy or chemoradiationPancreatic cancer treatment when clinically appropriateCovered
    Policy Summary
    PayerAmeriHealth Caritas VIP Care
    PolicyTumor Treating Fields for Pancreatic Cancer
    Policy CodePolicy CCP.1568
    Change TypeNo material change
    Effective DateSeptember 1, 2026
    Last ReviewAug 1, 2026
    Next Review DateDecember 1, 2027
    Key ActionClaims for tumor treating fields used for unresectable, locally advanced pancreatic cancer may be denied.
    SourceLink
    On This Page
    Coverage CriteriaRelated CodesProvider and Coverage ActionsClinical BackgroundKey DefinitionsLine of TherapyTreatment Regimens