CurrentCignaPolicy 0540

Ablative Treatments for Malignant Breast Tumors (cryoablation, microwave thermotherapy, radiofrequency ablation)

Defines Cigna's coverage stance on cryoablation, microwave thermotherapy, and radiofrequency ablation for malignant breast tumors for members covered under Cigna-administered health benefit plans.

Policy Summary

PayerCigna

PolicyAblative Treatments for Malignant Breast Tumors (cryoablation, microwave thermotherapy, radiofrequency ablation)

Policy CodePolicy 0540

Change TypeAnnual Review

Effective DateApr 15, 2025

Next Review DateMar 15, 2026

Key ActionDo not request authorization for cryoablation, microwave ablation, or radiofrequency ablation for malignant breast tumors because these services are considered not medically necessary and may be denied.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3Ablative techniques

0FDA‑approved devices

2Not medically necessary CPTs listed

75%Pooled efficacy

Coverage Criteria

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.

Not Medically Necessary

The following ablative treatments for malignant breast tumors are considered not medically necessary:

Ablative treatments labeled Not Medically Necessary: cryoablation

Not covered for malignant breast tumors.

Ablative treatments labeled Not Medically Necessary: microwave ablation

Not covered for malignant breast tumors.

Ablative treatments labeled Not Medically Necessary: radiofrequency ablation

Not covered for malignant breast tumors.

Considered Not Medically Necessary

Procedures identified as "Considered Not Medically Necessary" in this document are not covered.

Not Medically Necessary Codes: Services billed with CPT 19499 (Unlisted procedure, breast) for ablation of breast tumors are considered not medically necessary per this policy.

Claims billed with this code for breast tumor ablation may be denied or not reimbursed.

Not Medically Necessary Codes: Services billed with CPT 0581T (Ablation, malignant breast tumor(s), percutaneous, cryotherapy, including imaging guidance when performed, unilateral) are considered not medically necessary per this policy.

Claims billed with this code for breast tumor ablation may be denied or not reimbursed.

There are no FDA‑approved ablative devices specifically indicated for malignant breast tumors. National and specialty guidance notes the lack of devices approved for this indication and recommends that investigational use occur within formal data-collection efforts. Participation in registries and clinical trials is advised while evidence for percutaneous and transcutaneous ablative techniques (including cryoablation, microwave thermotherapy, and radiofrequency ablation) is emerging.

This policy explicitly lists CPT 19499 (Unlisted procedure, breast) and CPT 0581T (ablation, malignant breast tumor(s), percutaneous, cryotherapy, including imaging guidance when performed, unilateral) under the section titled “Considered Not Medically Necessary.” Services billed with these codes for ablative treatment of breast tumors are therefore identified as not covered.

Cryoablation, microwave ablation, and radiofrequency ablation for malignant breast tumors are considered not medically necessary and are not covered under this policy.

Use of CPT 19499 and CPT 0581T for the ablation of malignant breast tumors is specifically identified in this policy as Considered Not Medically Necessary. Claims submitted with these codes for this indication may be denied or not reimbursed.

Provider Actions and Billing Guidance

Prior Authorization

Prior Authorization Requirement and Denial Risk

Ablative treatments (cryoablation, microwave ablation, radiofrequency ablation) for malignant breast tumors are considered not medically necessary and may be denied. Providers must ensure services for these procedures are submitted with appropriate, covered diagnosis and procedure codes and include documentation that supports medical necessity when applicable.

Prior authorization: Verify any PA requirements with the member's plan prior to service; these ablative treatments are listed as Considered Not Medically Necessary and subject to denial.
Billing and coding: Submit services with covered diagnosis and procedure codes effective on the date of service; claims lacking covered codes will be denied.
Coding currency: Ensure submitted CPT/HCPCS codes are current and effective on the date of service; deleted or inactive codes at time of service may not be eligible for reimbursement.
Denial risk: Services billed using CPT 19499 or 0581T for ablative treatment of malignant breast tumors are identified in this policy as Considered Not Medically Necessary and are at high risk for denial.

Documentation Required

Billing and Coding Documentation

Providers should submit all services with covered diagnosis and procedure codes and include sufficient clinical documentation to support the billed service. Claims submitted without covered codes or without documentation demonstrating medical necessity (when required) will be denied as not covered.

Documentation expectation: clinical notes, imaging reports, and procedure details should be included when submitting claims that may require review.
Provider action: Verify that the diagnosis codes correspond to covered indications in the member’s benefit plan.
Operational note: Coverage determinations consider the terms of the applicable benefit plan document and may vary by line of business.

Billing Rule

Provider Coding Currency

Ensure the CPT/HCPCS codes submitted are current and effective on the date of service. Because AMA and CMS updates may occur more frequently than policy revisions, confirm coding currency before claim submission to avoid denials.

Codes of concern in this policy: CPT 19499 (unlisted procedure, breast) and 0581T (ablation, malignant breast tumor — cryotherapy) are listed as Not Medically Necessary for ablative treatment of malignant breast tumors.
Action: Replace unlisted or non-covered codes with the appropriate covered code when applicable and supported by documentation.

Definitions

inv-19: Cryoablation — definition and mechanism

DefinitionCryoablation (cryosurgery/cryotherapy): uses an extremely cold liquid or gas via a cryoprobe to freeze and destroy abnormal tissue through freezing and thawing cycles

Mechanisms of tumor cell destructionDirect intracellular ice formation and osmotic dehydration; indirect ischemic injury and immunologic response

Common cryogen agentsLiquid nitrogen, liquid nitrous oxide, or compressed argon gas used to cool the cryoprobe

inv-20: Microwave thermotherapy — definition and mechanism

DefinitionMicrowave thermotherapy (microwave therapy): exposes tumor to focused electromagnetic waves to generate localized heating and induce tissue necrosis

MechanismLocalized heating produced by movement of water molecules in tissue when exposed to focused microwaves, preferentially damaging high‑water‑content tumor cells

Tissue selectivityTechnique can spare lower‑water‑content tissues such as adipose and breast glandular tissue

inv-21: Radiofrequency ablation (RFA) — definition and mechanism

DefinitionRadiofrequency ablation (RFA): insertion of a needle electrode that delivers alternating current to generate ionic agitation and localized heating

MechanismHeat produced by alternating current causes coagulative necrosis and cell death; ablation volume is limited by the method and may require multiple probes for larger lesions

Technical noteHeat is generated by ionic agitation rather than the probe itself, which limits single‑probe ablation volume

inv-22: CPT 0581T — code description (ablation, malignant breast tumor(s), percutaneous, cryotherapy)

CPT code0581T

DescriptionAblation, malignant breast tumor(s), percutaneous, cryotherapy, including imaging guidance when performed, unilateral

Status in policyListed as Considered Not Medically Necessary for ablative treatment of breast tumors

inv-23: CPT 19499 — code description (unlisted procedure, breast)

CPT code19499

DescriptionUnlisted procedure, breast

Status in policyListed as Considered Not Medically Necessary when used for ablation of breast tumors

OpenPayer

Ablative Treatments for Malignant Breast Tumors (cryoablation, microwave thermotherapy, radiofrequency ablation)

Coverage Criteria

Coding

Provider Actions and Billing Guidance

Background

Definitions

19499	Unlisted procedure, breast.
0581T	Ablation, malignant breast tumor(s), percutaneous, cryotherapy, including imaging guidance when performed, unilateral