CurrentPremera BluecrossPolicy N/A

Microwave Tumor Ablation

Policy governing the use of microwave tumor ablation and related referenced medical policies; lists related policies and replacement relationships relevant to coverage determinations.

Policy Summary

PayerPremera Bluecross

PolicyMicrowave Tumor Ablation

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionProvide office visit notes documenting history, physical, tumor type, unresectable rationale, and tumor size when requesting coverage.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

≤5 cmmax liver tumor size (medical necessity)

≤3 cmmax lung tumor size (medical necessity)

1single tumor requirement

Sep. 13, 2025last review

noneMedicare NCD status

Coverage Criteria and Rationale

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.

Related policies and cross-references

Related medical policies to consult for procedures and alternative ablation or liver-directed therapies:

ALL of the following

ANY of the following
- Policy 7.01.92 — Cryosurgical Ablation of Miscellaneous Solid Tumors Other Than Liver, Prostate, or Dermatologic Tumors (read with).
- Policy 7.01.95 — Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver Tumors (read with).
- Policy 8.01.11 — Transcatheter Arterial Chemoembolization as a Treatment for Primary or Metastatic Liver Malignancies (read with).
- Policy 8.01.521 — Radioembolization for Primary and Metastatic Tumors of the Liver (read with).
- Note: policy history shows policy 8.01.43 replaced by 8.01.521; consult replacement relationships when reviewing radioembolization guidance.

ALL of the following

Consult the listed related policies when considering alternative or adjunctive locoregional liver-directed therapies, or when RFA/cryotherapy may be an option.

ALL of the following

These related-policy references are provided for cross-reference and do not themselves define the microwave ablation criteria in this policy.

Medical necessity and limits for microwave ablation

Covered when ALL of the following medical necessity conditions are met (documentation requirements below):

ALL of the following

Office visit notes document relevant history and physical, tumor type, rationale that the tumor is unresectable (with explanation), and the size of the tumor(s).
See Documentation Requirements.
Hepatic tumor
- Microwave ablation (MWA) of a primary or metastatic hepatic tumor when the tumor is unresectable due to location OR the individual has comorbid condition(s) contraindicating surgery; AND a single tumor ≤ 5 cm in size.
Pulmonary tumor
- MWA of a primary or metastatic lung tumor when the tumor is unresectable due to location OR the individual has comorbid condition(s) contraindicating surgery; AND a single tumor ≤ 3 cm in size.

Coverage summary

Coverage considerations and evidence-based points informing the policy stance:

ALL of the following

Guideline context: Professional guidelines (NCCN, ACCP, others) list MWA among locoregional or ablative options for selected patients—generally favoring ablation for smaller lesions (often <3 cm) and for patients who are medically inoperable or when tumors are accessible by percutaneous, laparoscopic, or open approaches.
Specifically, NCCN notes ablation may be curative for tumors ≤3 cm and that lesions 3–5 cm may require arterially directed therapies or combination approaches; ACCP indicates SBRT is generally preferred over ablation for many patients with early-stage NSCLC but ablation can be reasonable when SBRT is unsuitable.

Coverage-context statements

Statements regarding professional guidance, regulatory status, and coverage policy context:

ALL of the following

Multiple microwave ablation devices have received FDA 510(k) clearance for soft tissue ablation, including indications that cover partial or complete ablation of nonresectable liver tumors; some devices are cleared for percutaneous, laparoscopic, or open surgical use (FDA product code NEY).

Coding, Billing, and Regulatory Identifiers

mixed

No codes listed

Suggested CPT/HCPCS to report microwave ablation (use radiofrequency codes per AMA guidance)mixed

0944T	3D contour simulation of target liver lesion(s) and margin(s) for image-guided percutaneous microwave ablation.
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, radiofrequency, unilateral.
47382	Ablation, 1 or more liver tumor(s), percutaneous, radiofrequency.
50592	Ablation, 1 or more renal tumor(s), percutaneous, unilateral, radiofrequency.
60660	Ablation of 1 or more thyroid nodule(s), one lobe or the isthmus, percutaneous, including imaging guidance, radiofrequency (when used to report microwave tumor ablation).
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) (when used to report microwave tumor ablation).
60699	Unlisted procedure, endocrine system (for adrenal or thyroid tumors).
C9751	Bronchoscopy, rigid or flexible, transbronchial ablation of lesion(s) by microwave energy, including fluoroscopic guidance, when performed, with computed tomography acquisition(s) and 3D rendering, computer-assisted, image-guided navigation.

Technical parametersmixed

No codes listed

Regulatory identifiersmixed

FDA product code NEY

Product code used by FDA for MWA devices

Recent coding updatesCPT | HCPCS

0944T	CPT code added for microwave tumor ablation
60660	CPT code added for microwave tumor ablation
60661	CPT code added for microwave tumor ablation
C9751	HCPCS code noted as termed January 1, 2026

Suggested CPT/HCPCS to report microwave ablation (use radiofrequency codes per AMA guidance)mixed

0944T	3D contour simulation of target liver lesion(s) and margin(s) for image-guided percutaneous microwave ablation.
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, radiofrequency, unilateral.
47382	Ablation, 1 or more liver tumor(s), percutaneous, radiofrequency.
50592	Ablation, 1 or more renal tumor(s), percutaneous, unilateral, radiofrequency.
60660	Ablation of 1 or more thyroid nodule(s), one lobe or the isthmus, percutaneous, including imaging guidance, radiofrequency (when used to report microwave tumor ablation).
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) (when used to report microwave tumor ablation).
60699	Unlisted procedure, endocrine system (for adrenal or thyroid tumors).
C9751	Bronchoscopy, rigid or flexible, transbronchial ablation of lesion(s) by microwave energy, including fluoroscopic guidance, when performed, with computed tomography acquisition(s) and 3D rendering, computer-assisted, image-guided navigation.

Technical parametersmixed

No codes listed

Regulatory identifiersmixed

FDA product code NEY

Product code used by FDA for MWA devices

Technical parametersmixed

No codes listed

Recent coding updatesCPT | HCPCS

0944T	CPT code added for microwave tumor ablation
60660	CPT code added for microwave tumor ablation
60661	CPT code added for microwave tumor ablation
C9751	HCPCS code noted as termed January 1, 2026

Use of RF CPT codes

Reporting recommendationReport microwave tumor ablation using existing radiofrequency (RFA) CPT codes per AMA guidance because no unique MWA CPT code exists.

Example CPT codesCodes noted for reporting MWA include 47382 (percutaneous liver RFA), 32998 (percutaneous pulmonary RFA), and CPT 0944T (3D contour simulation for percutaneous MWA).

Thyroid/renal reportingUse RFA CPTs such as 60660/60661 for thyroid nodule ablation and 50592 for renal tumor ablation when reporting MWA in those sites.

Tumor size/number thresholds discussed in evidence

Liver tumor thresholdEvidence supports MWA for an unresectable single primary or metastatic hepatic tumor ≤5 cm.

Lung tumor thresholdEvidence supports MWA for an unresectable single primary or metastatic lung tumor ≤3 cm.

Multiple nodules guidanceComparable outcomes for MWA vs RFA reported for up to three nodules ≤3 cm each in hepatic disease; many guidelines favor lesions <3 cm.

Provider Requirements, Settings, and Authorization

Note

Informational: Provider responsibilities

Providers: document the clinical rationale for microwave ablation, including why the tumor is unresectable (anatomic/location reasons) or why the patient is not a surgical candidate (relevant comorbidities), and tumor size.

Include office visit notes with history and physical demonstrating tumor type, size, and rationale that lesion(s) are unresectable or surgery is contraindicated.

Prior Authorization

Prior Authorization / Documentation Guidance

Prior authorization may be required per payer. Submit documentation that supports medical necessity: office visit notes with relevant history and physical, tumor type, tumor size, and a clear rationale why lesion(s) are unresectable or why surgery is contraindicated.

Documentation must show tumor size (e.g., ≤5 cm for hepatic primary/metastatic; ≤3 cm for lung primary/metastatic when applicable).
If multiple tumors in the lung, note that MWA of >1 tumor is considered investigational per policy.

Documentation Required

Settings and Indications

Microwave ablation may be performed in appropriate procedural settings and approaches. Permissible settings and approaches include percutaneous, laparoscopic, thoracoscopic, or open procedures performed under image guidance (ultrasound, CT, or MRI) with local, moderate sedation, or general anesthesia as clinically indicated.

Technique may use a single or multiple antennas; multiple antennas may be used simultaneously to enlarge the ablation zone or treat multiple tumors.
Indications: primary or metastatic hepatic tumors (single tumor ≤5 cm) and primary or metastatic lung tumors (single tumor ≤3 cm) when unresectable or patient is not a surgical candidate.

Note

Coverage Verification

Coverage verification: Always consult the member benefit booklet or contact member/customer service to determine benefit limitations and prior authorization requirements. This policy does not apply to Medicare Advantage. There is no Medicare national coverage determination for this service.

Member contracts vary — confirm benefits and any applicable limits prior to scheduling.
Policy does not apply to Medicare Advantage plans.

Definitions and Guideline Statements

Microwave Tumor Ablation (policy context)

Definition (policy context)Microwave Tumor Ablation (MWA) is a thermal ablation technique that destroys tumors in situ using microwave energy delivered via a probe or antenna; it is an option when resection is not feasible or the patient is not a surgical candidate.

ApproachesMWA may be performed percutaneously, laparoscopically, thoracoscopically, or as an open procedure under image guidance (e.g., ultrasound, CT, MRI).

Clinical intentUsed to control local tumor growth, palliate symptoms, or potentially prolong survival in selected patients.

Microwave ablation (MWA) — technical description

Energy and frequenciesMWA uses microwave energy delivered via one or multiple antennae; typical operating frequencies are 915 MHz or 2.45 GHz (2.450 MHz/2.45 GHz referenced).

Antennae useA single antenna or multiple antennas connected to a generator are inserted into the tumor; tumors >2 cm often treated with 2–3 antennas simultaneously.

Ablation zoneTypical resulting ablation zone from a single antenna is approximately a 2–3 cm elliptical area, with tissue coagulation occurring rapidly after energy delivery.

Medically necessary (as applied)

Medically necessary — liverMWA of primary or metastatic hepatic tumors is considered medically necessary when the tumor is unresectable or surgery is contraindicated and a single tumor is ≤5 cm.

Medically necessary — lungMWA of primary or metastatic lung tumors is considered medically necessary when the tumor is unresectable or surgery is contraindicated and a single tumor is ≤3 cm.

LimitationsMWA of more than one primary or metastatic lung tumor is considered investigational; evidence sufficiency conclusions generally apply to individuals with single tumors.

Microwave ablation (MWA) — procedural mechanism and expected effect

MechanismMWA induces an alternating electromagnetic field that causes water molecule rotation and frictional heating, producing rapid thermal coagulation and localized tissue necrosis.

Time course and effectTissue ablation occurs quickly (within about one minute after a pulse); killed cells remain and are gradually replaced by fibrosis and scar tissue; margins may be sites of local recurrence.

Practical outcomesMWA can control local tumor growth, palliate symptoms, and potentially prolong survival in selected unresectable tumors.

Heat-sink effect

DefinitionHeat-sink effect is the cooling of target tissue by adjacent blood flow in large vessels, which can reduce ablation effectiveness.

Relevance to ablationThe heat-sink effect can lead to incomplete tumor ablation when adjacent large vessels dissipate heat generated by the probe.

MWA advantageBecause MWA achieves higher active heating (>100°C) and does not rely on passive conduction, it can overcome the heat-sink effect better than RFA in some settings.

FDA-cleared MWA device

Regulatory statusMultiple MWA devices have FDA 510(k) clearance for coagulation/ablation of soft tissue, including partial or complete ablation of nonresectable liver tumors.

Specific product codeFDA product code listed for MWA devices is NEY.

Use indicationsSome devices are specifically cleared for percutaneous, laparoscopic, and open surgical use; clearances based on substantial equivalence to existing RFA/MWA devices.

SAGES/AHPBA guideline statement (2023)

Guideline statement (SAGES/AHPBA 2023)The 2023 SAGES/AHPBA panel recommended that MWA or RFA can be utilized in patients with HCC and colorectal liver metastases but emphasized that available evidence was poor quality and treatment decisions should be individualized.

ImplicationSociety guidance supports use but underscores need for individualized decision-making due to low-quality evidence.

Medical policy

Purpose of medical policyMedical policy provides systematically developed guidelines to inform coverage determinations and is a resource for staff evaluating medical necessity.

Scope and applicabilityCoverage is subject to member benefit plan limits; members and providers should consult the member benefit booklet or customer service to determine specific coverage; policy does not apply to Medicare Advantage.

Policy developmentPolicies are adopted after review of peer-reviewed literature, national guidelines, and local standards; the Company may update policies as appropriate.