CurrentBlue Cross Blue Shield - MassachusettsPolicy N/A

Hematology and Oncology Medical Policy Group - Coverage Criteria and Updates

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Summary of the Hematology and Oncology Medical Policy Group meeting, agenda items, policy updates, and related policy references affecting Blue Cross Blue Shield - Massachusetts medical policy management for oncology and hematology.

Policy Summary

PayerBlue Cross Blue Shield - Massachusetts

PolicyHematology and Oncology Medical Policy Group - Coverage Criteria and Updates

Policy CodePolicy N/A

Change TypeCoding and authorization updatesinvestigational determinations

Effective DateFeb 24, 2026

Last ReviewJun 1, 2025

Next Review DateN/A

Key ActionObtain prior authorization through Carelon for procedures associated with HCPCS code A9616.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1meeting on

A9616HCPCS added

12/1/2025TTFields effective

4/1/2025IE investigational

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CurrentBlue Cross Blue Shield - MassachusettsPolicy N/A

Hematology and Oncology Medical Policy Group - Coverage Criteria and Updates

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Know when Blue Cross Blue Shield - Massachusetts releases new policies or updates existing guidance.

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Policy Summary

PayerBlue Cross Blue Shield - Massachusetts

PolicyHematology and Oncology Medical Policy Group - Coverage Criteria and Updates

Policy CodePolicy N/A

Change TypeCoding and authorization updatesinvestigational determinations

Effective DateFeb 24, 2026

Last ReviewJun 1, 2025

Next Review DateN/A

Key ActionObtain prior authorization through Carelon for procedures associated with HCPCS code A9616.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1meeting on

A9616HCPCS added

12/1/2025TTFields effective

4/1/2025IE investigational

Coverage Criteria

Irreversible electroporation is considered investigational for the treatment of tumors located in the liver, pancreas, kidney, and lung.

Procedure	Anatomic sites / indications	Coverage status	Notes / effective date
Irreversible electroporation
Liver tumors

Declared investigational for treatment of liver tumors; policy statement effective April 1, 2025.

Procedure / therapy	Indication	Coverage status	Notes / effective date
Tumor Treating Fields
Newly diagnosed glioblastoma

New medical policy describes Tumor Treating Fields as medically necessary for newly diagnosed glioblastoma; effective December 1, 2025.

Coding and Billing

Updated HCPCS codes requiring prior authorizationHCPCS

A9616

HCPCS code A9616 (added to a revised policy)

Provider Actions and Authorization

Prior Authorization

Prior authorization required through Carelon for HCPCS A9616

Prior authorization is required through Carelon for procedures associated with HCPCS code A9616. Outpatient procedure codes requiring prior authorization are listed in the Outpatient Prior Authorization Code List policy and must be routed through Carelon.

HCPCS code A9616 was added to a revised policy and requires prior authorization via Carelon.

Prior Authorization

Authorization routing: A9616 must be authorized via Carelon

HCPCS code A9616 was added to a revised policy and prior authorization for services billed with this code must be obtained through Carelon.

Authorization routing must use the Carelon Medical Benefits Management Program referenced in the policy update.

Step Therapy

Medicare Advantage Part B step therapy applies to non-oncology indications

Medicare Advantage Part B has a separate medical utilization management (step therapy) policy for non-oncology indications of drugs that have both oncology and non-oncology uses; follow Medicare Advantage Part B Utilization Management guidance for those indications and follow hematology/oncology policies for oncology supportive care.

Refer to the Medicare Advantage Part B Utilization Management policy for step therapy requirements for non-oncology indications.
For oncology supportive care, follow the hematology/oncology program policies instead of the Part B step therapy rules.

Documentation Required

Contact and coordination: use ebr@bcbsma.com and reference Carelon

For questions or coordination related to Carelon-managed prior authorization, contact ebr@bcbsma.com and reference Carelon (formerly AIM) program policies; outpatient procedures may require prior authorization per the Outpatient Prior Authorization Code List policy.

Email ebr@bcbsma.com for authorization questions and coordination.
Reference the Carelon (formerly AIM) Medical Benefits Management Program policies when submitting requests.

Definitions

Carelon — definition

NameCarelon

Former nameAIM

RoleMedical benefits management and utilization management program used by BCBSMA to manage prior authorization for advanced imaging, genetic testing, oncology-related services and other medical benefits.

Contact for questionsebr@bcbsma.com

Carelon (formerly AIM) — Medical Benefits Management Program

Program nameCarelon Medical Benefits Management Program (formerly AIM)

ScopeManages prior authorization and utilization management for advanced imaging, genetic testing, oncology drug regimens, radiation oncology, and other outpatient medical services.

Background

This document is a meeting agenda and policy update summary from the Hematology and Oncology Medical Policy Group. It documents recent policy actions, coding updates, and new or revised policies relevant to oncology care management, including the addition of new and revised drug and therapy policies and adoption of outpatient prior authorization procedures.

Key items discussed by the group include policy revisions and new policy releases (for example, updated engineered T‑cell and supportive therapy policies), the introduction of an Outpatient Prior Authorization Code List, a Medicare Advantage Management guide and a new Medicare Advantage Part B Step Therapy policy, and the formal determination that irreversible electroporation is investigational for tumors of the liver, pancreas, kidney, and lung (effective April 1, 2025).

Changes and Revision History

2026-02-24policy_reviewedLatest

Hematology and Oncology Medical Policy Group meeting held on February 24, 2026, discussing multiple policy updates including prior authorization and coding changes.

2025-12-01new_policy_effective

New medical policy for Tumor Treating Fields therapy describing medically necessary indications for newly diagnosed glioblastoma became effective.

2025-09-15