CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Cryosurgical ablation of liver tumors — Coverage Criteria

This policy addresses coverage and medical necessity for cryosurgical ablation (CSA) of primary or metastatic liver tumors for Blue Cross Blue Shield - Rhode Island members, including Medicare and Commercial lines.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyCryosurgical ablation of liver tumors — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective Date02|17|2015

Next Review DateN/A

Key ActionVerify member benefits and authorization/coverage with the provider call center before proceeding.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Not medically necessaryCommercial stance

Not coveredMedicare stance

3 codesCPT codes listed

09|18|2018Last updated

Coverage determination for cryosurgical ablation (CSA) of liver tumors

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Overall coverage determination

Covered when ALL of the following are met:

Medicare stance: Cryosurgical ablation of either primary or metastatic tumors in the liver is not covered by BlueCHiP for Medicare because the evidence is insufficient to determine the effects of the technology on health outcomes.

From BlueCHiP for Medicare coverage statement

Commercial stance: Cryosurgical ablation of either primary or metastatic tumors in the liver is not medically necessary for Commercial members because the evidence is insufficient to determine the effects of the technology on health outcomes.

From Commercial coverage statement

Evidence summary: Randomized and nonrandomized studies (including RCTs and systematic reviews) have evaluated CSA for unresectable primary hepatocellular carcinoma and liver metastases (colorectal and neuroendocrine). Trials show mixed results versus radiofrequency ablation and surgical resection, with concerns about bias and insufficient comparative evidence to determine effects on overall survival or other health outcomes.

See Background evidence discussion

Actions and precautions for providers

Prior Authorization

Prior Authorization / Benefit Verification

Prior authorization: Not applicable. Verify member benefits as requirements and coverage vary by contract; refer to the member's Evidence of Coverage or Subscriber Agreement for applicable benefits, coverage limitations, and cost-sharing.

Prior authorization: Not applicable
Benefit verification: Verify member benefits and eligibility prior to service; benefits vary by contract
Evidence of Coverage / Subscriber Agreement: Primary source for coverage determinations
Provider call center: Contact for member-specific benefit questions

Step Therapy

Step therapy: No step therapy requirements specified.

Note

Verify Member Benefits

Verify member benefits: Coverage and medical necessity determinations vary by contract. Refer to the Evidence of Coverage or Subscriber Agreement and contact the provider call center for member-specific information.

Benefits vary by contract — check Evidence of Coverage/Subscriber Agreement
Contact provider call center for member-specific determinations

Denial Risk

Denial Risk for Cryosurgical Ablation of Liver Tumors

Denial risk: Cryosurgical ablation of liver tumors may be denied. For BlueCHiP for Medicare this service is not covered; for Commercial plans it is considered not medically necessary. Claims may be rejected or denied accordingly.

Medicare (BlueCHiP): Not covered — claims may be denied as not covered
Commercial: Not medically necessary — claims may be denied as not medically necessary
Affected CPT codes: 47371, 47381, 47383

Clinical background

Cryosurgical ablation (CSA) is a procedure that destroys target tissue by freezing. The technique uses a probe inserted into the tumor through which coolant is circulated to create an ice ball that causes cellular injury and tumor necrosis. CSA can be performed via an open surgical approach, a percutaneous approach, or using laparoscopic techniques, and is commonly performed under image guidance such as ultrasound.

Definitions

Cryosurgical ablation (CSA) — definition and approaches

DefinitionCryosurgical ablation (CSA) involves freezing target tissues by inserting into the tumor a probe through which coolant is circulated.

Approach — Open surgicalCan be performed as an open surgical technique.

Approach — PercutaneousCan be performed percutaneously, typically with ultrasound guidance.

Approach — LaparoscopicCan be performed laparoscopically, typically with ultrasound guidance.

GuidanceProcedures are typically performed with ultrasound guidance.