CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Medical Coverage Policy Local or Whole Body Hyperthermia

Defines medical necessity and coverage for local and whole-body hyperthermia therapy for cancer for Medicare Advantage plans and Commercial products, including CPT code guidance and exclusions.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyMedical Coverage Policy Local or Whole Body Hyperthermia

Policy CodePolicy N/A

Change TypeNo material change

Effective DateAug 1, 2008

Next Review Date

Key ActionProviders must document that local hyperthermia is being used in combination with radiation therapy for primary or metastatic cutaneous or subcutaneous superficial tumors to meet medical necessity.

SourceLink

POLICY UPDATE CHANGES

No material clinical/coverage changes

3Covered CPT codes for local hyperthermia

2CPT codes not covered / not medically necessary

1Whole-body hyperthermia coding: unlisted

Coverage Summary

Scope: Defines medical necessity and coverage for local and whole-body hyperthermia therapy for cancer for Medicare Advantage plans and Commercial products, including CPT code guidance and exclusions. (Effective date: 2008-08-01; Status: CURRENT.)

Background: Local hyperthermia elevates the temperature of superficial or subcutaneous tumors to augment cancer treatments and may be considered medically necessary when used in combination with radiation therapy for primary or metastatic cutaneous or subcutaneous superficial tumors. Whole-body hyperthermia raises core body temperature and requires general anesthesia or deep sedation with prolonged monitoring; evidence is considered inadequate to determine effects on health outcomes for whole-body hyperthermia and for local hyperthermia when used alone or in combination with chemotherapy.

Medical Necessity Criteria

Medicare Advantage Plans and Commercial Products - Local Hyperthermia

Local hyperthermia therapy may be considered medically necessary when ALL of the following are met:

ALL of the following

ALL of the following
- Used in combination with radiation therapy
- Treatment of patients with primary OR metastatic cutaneous OR subcutaneous superficial tumors

Not covered / Not medically necessary for Local Hyperthermia

When used alone
When used in combination with chemotherapy

Medicare Advantage Plans and Commercial Products - Whole-body Hyperthermia

Whole-body hyperthermia therapy coverage determination:

Whole-body hyperthermia therapy is not covered for Medicare Advantage Plans

Whole-body hyperthermia therapy is not medically necessary for Commercial products

Coding

Covered for local hyperthermiaCPTCovered

77600	Hyperthermia, externally generated; superficial (ie, heating to a depth of 4 cm or less)
77610	Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators
77615	Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators

Not covered / Not medically necessaryCPTNot Covered

77620	Hyperthermia generated by intracavitary probe(s)
77605	Hyperthermia, externally generated; deep (ie, to depths greater than 4 cm) heating

Whole-body hyperthermia reportingCPT

unlisted

No specific CPT procedure code for whole-body hyperthermia; report using an appropriate unlisted CPT code

Provider Actions

Documentation Required

Document combination with radiation therapy for local hyperthermia

Providers must document that local hyperthermia is being used in combination with radiation therapy for primary or metastatic cutaneous or subcutaneous superficial tumors to meet medical necessity.

77600
77610
77615

Denial Risk

Claims risk for local hyperthermia used alone or with chemotherapy

Claims for local hyperthermia when used alone or in combination with chemotherapy are not covered/not medically necessary and may be denied.

77600
77610
77615
77605
77620

Billing Rule

Report whole-body hyperthermia with unlisted CPT

There is no specific CPT procedure code for whole-body hyperthermia; report use of whole-body hyperthermia with an appropriate unlisted code.

unlisted

Background & Evidence

Local hyperthermia: Elevation of temperature of superficial or subcutaneous tumors (externally or interstitially) to depths ≤4 cm for superficial techniques; used to make tumors more susceptible to other cancer treatments.

Whole-body hyperthermia: Systemic thermotherapy that raises core body temperature (document describes increases to about 108°F), requires general anesthesia or deep sedation, maintenance of elevated temperature for several hours with extended monitoring and observation.

Local hyperthermia elevates the temperature of superficial or subcutaneous tumors (externally or interstitially) to augment treatments; local hyperthermia may be medically necessary when used in combination with radiation therapy for primary or metastatic cutaneous or subcutaneous superficial tumors, but the evidence is considered inadequate to support local hyperthermia when used alone or in combination with chemotherapy.

Whole-body hyperthermia raises core temperature and requires placement of the patient under general anesthesia or deep sedation, prolonged maintenance of elevated temperature (described to ~108°F), and extended monitoring and observation; the evidence is considered inadequate to determine effects on health outcomes for whole-body hyperthermia.

Source	Detail
CMS NCD reference
NCD for Hyperthermia for Treatment of Cancer (110.1) cited (Centers for Medicare and Medicaid Services).
Randomized trials referenced
Multiple randomized trials and phase studies cited (e.g., RTOG, Radiation Therapy Oncology Group randomized and phase studies; International Collaborative Hyperthermia Group trials; Vernon et al.; Perez et al.; Emami et al.).

Name	NCD Number	Type	Effective Date
Hyperthermia for Treatment of Cancer
110.1
NCD