CurrentBlue Cross Blue Shield - MassachusettsPolicy 546

Handheld Radiofrequency Spectroscopy for Intraoperative Assessment of Surgical Margins During Breast-Conserving Surgery

Defines coverage position for handheld radiofrequency spectroscopy (eg, MarginProbe) used intraoperatively to assess surgical margins during breast-conserving surgery for Commercial and Medicare products administered by Blue Cross Blue Shield Massachusetts, including prior authorization requirements for inpatient procedures and outpatient coverage status by product.

Policy Summary

PayerBlue Cross Blue Shield - Massachusetts

PolicyHandheld Radiofrequency Spectroscopy for Intraoperative Assessment of Surgical Margins During Breast-Conserving Surgery

Policy CodePolicy 546

Change TypeAnnual review; policy statements unchanged

Effective DateFeb 1, 2014

Next Review Date

Key ActionPrecertification/preauthorization is required for all products if the procedure is performed inpatient.

POLICY UPDATE CHANGES

4/2025 Annual policy review. References updated. Policy statements unchanged.

4/2024 Annual policy review. Description, summary, and references updated. Policy statements unchanged.

2/2014 New medical policy describing investigational indications. Effective 2/1/2014.

1Investigational CPT code listed

0Covered indications

11Most recent reference count

Coverage Summary

Policy covers handheld radiofrequency spectroscopy (eg, MarginProbe) for intraoperative assessment of surgical margins during breast‑conserving surgery and states the technology is investigational. Coverage applies to Commercial and Medicare products administered by Blue Cross Blue Shield Massachusetts; the device/procedure is designated as not a covered outpatient service across product lines, and prior authorization is required for inpatient procedures.

Evidence conclusion: Insufficient to determine that handheld radiofrequency spectroscopy improves net health outcomes; diagnostic performance shows moderate sensitivity and poor specificity.

Key randomized trial: randomized study had important limitations — the control arm did not use histologic margin assessment, the outcome measure was biased against the control arm, and follow‑up was inadequate to assess local recurrence; difference in re‑excision rates was not statistically significant.

FDA SSED: MarginProbe System Summary of Safety and Effectiveness Data (2012) is referenced as the FDA review supporting device clearance.

Coding

Investigational CPT code(s)CPTNot Covered

0546T

Radiofrequency spectroscopy, real time, intraoperative margin assessment, at the time of partial mastectomy, with report

Documentation Required

Coding and reporting

Providers should report all services using the most up-to-date industry-standard procedure, revenue, and diagnosis codes, including modifiers where applicable.

Provider Actions

Prior Authorization

Precertification/Preauthorization for inpatient procedures

Precertification/preauthorization is required for all products if the procedure is performed inpatient.

Denial Risk

Coverage consequence — outpatient settings

Handheld radiofrequency spectroscopy (MarginProbe) for intraoperative assessment of surgical margins is considered investigational and, for outpatient settings, is not a covered service for the listed products (Commercial Managed Care HMO/POS, Commercial PPO and Indemnity, Medicare HMO Blue, Medicare PPO Blue).

Background and Definitions

MarginProbe is a handheld intraoperative radiofrequency spectroscopy device that measures dielectric properties of lumpectomy specimen touches and gives a positive/negative reading for each touch; it is intended to help surgeons achieve clear margins at the initial lumpectomy and reduce re‑excisions.

Available evidence includes a randomized trial, historical controls, and systematic reviews but is limited: diagnostic accuracy shows only moderate sensitivity and poor specificity, randomized trial design and follow‑up limitations prevent reliable assessment of recurrence or net health benefit, and therefore current evidence is insufficient to conclude improved patient outcomes.

Term	Definition
MarginProbe	A handheld intraoperative radiofrequency spectroscopy device that analyzes lumpectomy specimen touches and gives positive or negative readings for tissue margins.
Investigational	Not demonstrated to improve net health outcomes; not a covered service per this policy.

Evidence Summary

Evidence conclusion: Insufficient evidence that handheld radiofrequency spectroscopy improves net health outcomes; device shows moderate sensitivity and poor specificity.

Key randomized trial limitations: Control arm did not use histologic margin examination, outcome measure was biased against control, follow‑up was insufficient to assess local recurrence, and the re‑excision difference was not statistically significant.

FDA SSED: MarginProbe System Summary of Safety and Effectiveness Data (2012) is cited as the FDA review document.

Revision History

4/2025annual_reviewLatest