Radiofrequency ablation (RFA) of tumors
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This policy describes coverage, criteria, and coding for radiofrequency ablation (RFA) of tumors for Medicare Advantage and Commercial products from Blue Cross Blue Shield - Rhode Island, including indications such as primary and metastatic lung tumors, bone metastases palliation, and osteoid osteomas.
No material clinical or coverage changes in this revision.
Coverage Criteria for Radiofrequency Ablation (RFA)
RFA for isolated peripheral NSCLC (covered)
Covered when ALL of the following are met for isolated peripheral primary NSCLC lesion:
RFA for malignant nonpulmonary tumors metastatic to lung (covered)
Covered when ALL of the following are met for malignant nonpulmonary tumors metastatic to the lung:
RFA for palliation of painful bone metastases (covered)
Covered when ALL of the following are met for palliative treatment of painful osteolytic bone metastases:
RFA may be used to provide clinically significant pain relief or reduce opioid use when other options are limited.
RFA for osteoid osteoma (covered)
Covered when ALL of the following are met for osteoid osteoma:
RFA achieves high clinical success (pain-free rates ~94%–98%) with low recurrence (approximately 5%–10%) and fewer complications compared with more invasive surgical excision.
Not covered / Not medically necessary indications
Not covered / Insufficient evidence for these tumor sites:
Evidence is insufficient to determine improved health outcomes for these indications.
The policy differentiates coverage by tumor site and product. Radiofrequency ablation (RFA) is described as covered when the medical criteria are met for specified indications (eg, selected pulmonary and bone indications). Tumors “outside the liver, including, but not limited to” sites such as the breast, head and neck, thyroid, pancreas, adrenal gland, ovary, and pelvic/abdominal metastases of unspecified origin are not covered for Medicare Advantage Plans and are not medically necessary for Commercial Products, because evidence is insufficient to demonstrate improved health outcomes for these indications.
Specific procedure coding reflects this distinction: pulmonary and bone RFA CPT codes (eg, 32998, 20982) are listed as medically necessary when criteria are met, while new thyroid RFA codes (60660, 60661) and other nonlisted-site procedures are identified as not covered / not medically necessary or require use of an appropriate unlisted CPT code.
Coverage and payment for services are governed by the member’s specific benefit documents. Benefits and eligibility are determined by the member’s subscriber agreement, member certificate, and/or employer agreement, and those documents supersede the provisions of this medical policy. Providers should verify member-specific benefits and eligibility through the provider call center prior to delivering services.
Indications not listed among the policy’s covered sites are treated differently depending on product: such indications are expressly stated as not covered for Medicare Advantage Plans and not medically necessary for Commercial Products. This includes, but is not limited to, tumors of the breast, head and neck, malignant thyroid disease, pancreas, adrenal gland, ovary, and unspecified pelvic/abdominal metastases. When an indication is outside the covered list, the policy finds the evidence insufficient to support coverage.
If a service is determined to be not medically necessary or is a non-covered benefit, it may be denied. Providers may not charge the member for such services unless the member has been informed and has agreed in writing in advance to accept financial responsibility. Verify member benefits and ensure any required written member agreement is obtained before billing the member for non-covered or not medically necessary services.
Coding and Billing
| 20982 | Ablation therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; radiofrequency |
| 32998 | Ablation therapy for reduction or eradication of 1 or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, including imaging guidance when performed, unilateral; radiofrequency |
| 60660 | Ablation of 1 or more thyroid nodule(s), one lobe or the isthmus, percutaneous, including imaging guidance, radiofrequency (New Code Effective 1/1/2025) |
| 60661 | Ablation of 1 or more thyroid nodule(s), additional lobe, percutaneous, including imaging guidance, radiofrequency (list separately in addition to code for primary procedure) (New Code Effective 1/1/2025) |
| unlisted | Appropriate unlisted CPT code should be used for indications including, but not limited to, tumors of the breast, head and neck, pancreas, adrenal gland, ovary and pelvic/abdominal metastases of unspecified origin for which there are no specific CPT codes. |
Provider Actions and Requirements
Verify benefits and eligibility
Verify member-specific benefits and eligibility before scheduling RFA; benefits and eligibility are determined by the member's subscriber agreement or employer agreement and supersede this medical policy.
- Contact the provider call center for member-specific benefit information.
Step required before RFA for bone metastases
For palliative treatment of painful osteolytic bone metastases, RFA is covered only when the individual has failed or is a poor candidate for standard treatments (for example, radiation or opioids).
- Document prior treatment attempts or reasons the patient is a poor candidate for standard therapy.
Obtain web-based prior authorization with supporting documentation
Obtain prior authorization via the web-based tool and include procedure-specific CPT codes and documentation showing the patient meets coverage criteria.
- Include clinical documentation that demonstrates the indication meets the policy's medical criteria.
- Prior authorization is obtained through the payer's online tool for participating providers.
Use online preauthorization tool (see related policy)
Prior authorization is recommended and is obtained using the payer's online preauthorization tool; see the related policy 'Preauthorization via Web-Based Tool for Procedures' for submission details.
- Follow the related policy for required submission fields and supporting documents.
Document benefits verification and obtain member agreement when needed
Verify benefits and eligibility with the provider call center and secure a written member agreement if billing for services that may be non-covered or not medically necessary.
- If services are determined not medically necessary or non-covered, the provider may not bill the member unless the member has agreed in writing in advance.
Do not perform RFA for listed non-covered indications expecting coverage
RFA performed for indications outside the covered list (for example: breast, head and neck, malignant thyroid, pancreas, adrenal gland, ovary, and unspecified pelvic/abdominal metastases) is considered not covered for Medicare Advantage Plans and not medically necessary for Commercial Products.
- Do not bill these indications expecting coverage; consider alternative management or obtain member agreement before proceeding.
Denial risk if service is non-covered or not medically necessary
Services determined to be not medically necessary or non-covered may be denied and the provider may not charge the member unless the member has been informed and has provided prior written agreement to pay.
- Confirm coverage before providing services to avoid denials and unexpected member liability.
- Keep written member agreements on file if proceeding with non-covered care at the member's expense.
Background and Procedure Overview
Radiofrequency ablation (RFA) is a percutaneous, laparoscopic, or open technique in which a probe is inserted into the tumor and alternating high-frequency current generates localized heat to ablate tissue. The thermal injury produces a roughly spherical zone of coagulative necrosis typically in the range of 3 to 5.5 cm in diameter, depending on device and technique. RFA can be used to control local tumor growth, provide symptom palliation, or offer a treatment option for patients who are not candidates for surgery.
Procedures carry risks related to thermal injury of adjacent structures and mechanical tract injury (for example, pneumothorax with lung procedures), and there is a theoretical risk of tumor seeding along the probe track. These potential complications should be considered when selecting patients and planning the procedure.
Definitions and Potential Complications
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