Irreversible Electroporation (IRE) of Tumors Other Than Liver
Customize your policy alerts
Sign up for all Blue Cross Blue Shield - Rhode Island policy alerts
Know when Blue Cross Blue Shield - Rhode Island releases new policies or updates existing guidance.
Monitor payer policy activity
Defines coverage, prior authorization, and medical necessity stance for IRE procedures performed for tumors other than the liver for Medicare Advantage and Commercial products of the payer.
No material clinical or coverage changes in this revision.
Coverage Determinations
Not covered / Not medically necessary
Covered when ALL of the following are met:
Evidence insufficient to demonstrate improved net health outcome; see organ-specific evidence summaries.
The following CPT code(s) are not covered for Medicare Advantage Plans and not medically necessary for Commercial Products when filed for irreversible electroporation (IRE) of tumors other than the liver: 0601T (Ablation, irreversible electroporation; 1 or more tumors per organ, including fluoroscopic and ultrasound guidance, when performed, open).
Irreversible electroporation (IRE) for treatment of primary or metastatic solid tumors, including but not limited to tumors of the pancreas, kidney, lung, and prostate, is considered not covered for Medicare Advantage Plans and not medically necessary for Commercial Products due to insufficient evidence of improved net health outcome.
Procedure Codes and Coding Notes
| 55877 | Ablation, irreversible electroporation, prostate, 1 or more tumors, including imaging guidance, percutaneous (New Code Effective 1/1/2026) |
| 0600T | Ablation, irreversible electroporation; 1 or more tumors per organ, other than liver or prostate, including imaging guidance, when performed, percutaneous (Text Revised Effective 1/1/2026) |
| 0601T | Ablation, irreversible electroporation; 1 or more tumors per organ, including fluoroscopic and ultrasound guidance, when performed, open |
Provider Requirements and Billing Actions
Prior Authorization Required for CPT 0601T
Prior Authorization is required for CPT code 0601T for Medicare Advantage plans and is recommended for Commercial products. This code is not specific to tumor location (e.g., liver, pancreas, kidney, lung, prostate).
- Affected code: CPT 0601T
- Prior authorization required: Medicare Advantage Plans
- Prior authorization recommended: Commercial Products
Confirm Benefits / Eligibility
Benefits and coverage may vary by contract. Providers should verify member-specific benefits and eligibility before providing services. Refer to the member's Evidence of Coverage or Subscriber Agreement for applicable surgical benefits and coverage.
- Check Evidence of Coverage or Subscriber Agreement
- For member-specific benefits, call the provider call center
Benefit Verification
Providers must verify benefits and coverage prior to rendering services because benefits and requirements can vary by contract. For member-specific benefit information, consult the subscriber agreement or call the provider call center.
- Verify benefits: Evidence of Coverage or Subscriber Agreement
- Contact: Provider call center for member-specific questions
Potential Denial Risk for Non‑Covered or Not Medically Necessary Services
Services determined to be not medically necessary or non-covered may be denied and could result in financial liability to the member or provider if performed without documented informed consent for self-pay. Providers must inform members and obtain written agreement before proceeding with non-covered services.
- Claims for IRE of non-liver tumors (e.g., pancreas, kidney, lung, prostate) may be denied or considered not medically necessary
- If service is non-covered or NMN, provider may not charge member unless the member has been informed and agreed in writing to self-pay
Background and Rationale
Irreversible electroporation (IRE) is a non-thermal ablation technique that delivers high-frequency electric pulses between electrodes to create an electric field that permanently disrupts cell membranes and causes cell death while preserving surrounding structural tissues such as blood vessels, nerves, and extracellular matrix. It is being investigated as a locoregional therapy for tumors in situations where thermal ablation may risk adjacent critical structures, but current evidence for non-liver indications relies primarily on single-arm observational studies and systematic reviews without sufficient comparative data to demonstrate improved net health outcomes.
Key Definitions
Therapy Line and Usage
salvage
No line-of-therapy coverage is approved; see organ-specific evidence summaries and NCCN guidance noting IRE as experimental or for clinical trials.
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.