Modifiedpriority healthPolicy 91548

Intraperitoneal Chemotherapy (HIPEC/IPHC and PIPAC)

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Defines medical necessity and coding for advanced intraperitoneal chemotherapy techniques (HIPEC/IPHC and PIPAC) for treatment of peritoneal malignancies and explains applicability to Priority Health products and member benefits.

Policy Summary

Payerpriority health

PolicyIntraperitoneal Chemotherapy (HIPEC/IPHC and PIPAC)

Policy CodePolicy 91548

Change TypeInclusion of PIPAC as E/I/Ucoding updates

Effective DateAug 1, 2026

Last ReviewMay 13, 2026

Next Review DateMay 13, 2026

Key ActionSubmit prior authorization requests where required and document medical necessity; use updated PIPAC-specific codes on authorization requests.

SourceLink

POLICY UPDATE CHANGES

Added Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) as an experimental/investigational/unproven (E/I/U) technology for all indications.

Updated coding to include codes relevant to PIPAC.

Policy scope and name revised to reflect inclusion of PIPAC.

Removed section 'B' regarding clinical trial coverage for HIPEC not recommended by NCCN.

Updated background and references.

4tumor types listed for HIPEC

E/I/U

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Modifiedpriority healthPolicy 91548

Intraperitoneal Chemotherapy (HIPEC/IPHC and PIPAC)

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Sign up for priority health Policy 91548 alerts

Get alerted when Policy 91548 changes without checking for updates manually.

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Policy Summary

Payerpriority health

PolicyIntraperitoneal Chemotherapy (HIPEC/IPHC and PIPAC)

Policy CodePolicy 91548

Change TypeInclusion of PIPAC as E/I/Ucoding updates

Effective DateAug 1, 2026

Last ReviewMay 13, 2026

Next Review DateMay 13, 2026

Key ActionSubmit prior authorization requests where required and document medical necessity; use updated PIPAC-specific codes on authorization requests.

SourceLink

POLICY UPDATE CHANGES

Added Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) as an experimental/investigational/unproven (E/I/U) technology for all indications.

Updated coding to include codes relevant to PIPAC.

Policy scope and name revised to reflect inclusion of PIPAC.

Removed section 'B' regarding clinical trial coverage for HIPEC not recommended by NCCN.

Updated background and references.

4tumor types listed for HIPEC

E/I/U

40-45°CHIPEC temperature

30-120 minHIPEC duration

RelocatedClinical trial language

Coverage Determinations

Medically Necessary: HIPEC/IPHC (per NCCN recommendations)

Intraperitoneal Hyperthermic Chemotherapy (IPHC/HIPEC) may be considered medically necessary when ALL of the following are met:

Indication per NCCN

Tumor types: Colon cancer; Gastric cancer; Peritoneal mesothelioma; Ovarian cancer (including epithelial ovarian cancer, fallopian tube cancer, and primary peritoneal cancer)

Not Medically Necessary / Experimental: PIPAC

PIPAC: Pressurized intraperitoneal aerosol chemotherapy (PIPAC), including but not limited to PIPAC using oxaliplatin, cisplatin/doxorubicin, or other chemotherapeutic agents, is considered Experimental, Investigational, and Unproven (E/I/U) for all indications

Includes PIPAC with oxaliplatin, cisplatin/doxorubicin, or other agents

PIPAC — Not medically established

Policy-level coverage stance and notable criteria updates (excerpted section):

PIPAC status: PIPAC is designated experimental/investigational/unproven for all indications

Per Summary of Changes: Added PIPAC as E/I/U and updated coding to include PIPAC-relevant codes

Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC), including but not limited to PIPAC using oxaliplatin, cisplatin/doxorubicin, or other chemotherapeutic agents, is considered Experimental, Investigational, and Unproven (E/I/U) for all indications. Current evidence is insufficient to demonstrate a definitive clinical or survival benefit.

PIPAC is designated as experimental/investigational/unproven and is excluded from routine coverage for all indications. This policy addition treats PIPAC as an E/I/U technology in coverage determinations.

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is classified as not medically necessary because it is considered experimental, investigational, and unproven for all indications; available data do not establish a clear clinical or survival benefit to support routine coverage.

Use of PIPAC for any indication is considered not medically necessary / experimental per this policy. The policy update adds PIPAC to the list of technologies designated E/I/U and notes that coding was updated to include PIPAC-relevant procedure codes for administrative handling.

Covered and Non-covered Regimens

Regimen	Indication / Notes	Coverage Status
Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC/IPHC)
Adjunct to cytoreductive surgery when recommended by applicable NCCN Guidelines; tumor types specifically listed in policy include: colon cancer; gastric cancer; peritoneal mesothelioma; ovarian cancer (including epithelial ovarian cancer, fallopian tube cancer, and primary peritoneal cancer). See PSOGI guidance for HIPEC regimens.
Covered when criteria met (NCCN-recommended indications)

Regimen	Agents / Delivery	Coverage Status
Pressurized intraperitoneal aerosol chemotherapy (PIPAC)
Includes PIPAC using oxaliplatin, cisplatin/doxorubicin, or other chemotherapeutic agents; delivered laparoscopically as a pressurized aerosol, typically without extensive cytoreduction and often used repeatably in unresectable or refractory peritoneal metastases.
Not covered — experimental / investigational / unproven for all indications

Regimen	Policy Statement	Coverage Status
Pressurized intraperitoneal aerosol chemotherapy (PIPAC)
Policy designation: PIPAC is considered Experimental, Investigational, and Unproven (E/I/U) for all indications; current evidence is insufficient to establish a definitive clinical or survival benefit. Services in the context of clinical trials are subject to the Plan's Clinical Trials policy and member benefits.
Not covered — experimental / investigational / unproven for all indications

Billing and Codes

ICD-10 Codes that may support medical necessityICD-10

C45.1	Mesothelioma of peritoneum
C48.0	Malignant neoplasm of retroperitoneum
C48.1	Malignant neoplasm of specified parts of peritoneum
C48.2	Malignant neoplasm of peritoneum, unspecified
C48.8	Malignant neoplasm of overlapping sites of retroperitoneum and peritoneum
C78.6	Secondary malignant neoplasm of retroperitoneum and peritoneum

CPT/HCPCS CodesCPT

49329	Unlisted laparoscopy procedure, abdomen, peritoneum and omentum
96547	Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure, including separate incision(s) and closure, when performed; first 60 minutes (List separately in addition to code for primary procedure)
96548	Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure, including separate incision(s) and closure, when performed; each additional 30 minutes (List separately in addition to code for primary procedure)
96446	Chemotherapy administration into peritoneal cavity
96549	Unlisted chemotherapy procedure

PIPAC-related codes (added)mixed

unspecified PIPAC codes

Policy states coding was updated to include PIPAC-relevant codes (exact codes listed elsewhere in full policy).

HIPEC-related codes (updated)mixed

96547/96548/96549

CPT/HCPCS codes referenced for intraoperative HIPEC procedures and related unlisted chemotherapy procedure; policy references updated coding for intraperitoneal chemotherapy procedures.

IPHC peritoneal infusate temperature range

Peritoneal infusate temperature40-45°C (104-113°F)

Typical infusate volume3–5 L circulated intraoperatively

Delivery methodHeated sterile chemotherapy solution circulated using pump systems (roller or peristaltic), temperature‑controlled container, tubing, and peritoneal temperature probes

IPHC exposure duration

Exposure duration range30–120 minutes

Typical usageCirculated intraoperatively immediately following cytoreductive surgery

Provider Responsibilities and Prior Authorization

Prior Authorization

Submit prior authorization when required

Prior authorization may be required for certain drugs, devices, services, and procedures; when required, providers must submit a request demonstrating that the drug, service, or procedure is medically necessary per the Priority Health Provider Manual.

Submit prior authorization requests when indicated on the Provider Manual.
Demonstrate medical necessity in the request documentation.

Prior Authorization

Use updated coding and request prior authorization for PIPAC

Prior authorization is required per plan policy where applicable and coding updates include PIPAC‑specific procedure codes; providers must use the updated procedure codes on authorization requests when submitting for PIPAC-related services.

Use the policy's updated coding that includes PIPAC-relevant procedure codes on authorization requests.
Ensure authorization requests reflect the revised policy scope that includes PIPAC.

Key Definitions

Intraperitoneal Hyperthermic Chemotherapy (HIPEC/IPHC)

DefinitionIntraperitoneal Hyperthermic Chemotherapy (HIPEC/IPHC) is the intraoperative circulation of a heated sterile chemotherapy solution in the peritoneal cavity immediately following cytoreductive surgery to enhance locoregional cytotoxicity.

Typical parametersHeated solution (3–5 L) circulated using roller or peristaltic pumps with temperature probes; infusate typically 40–45°C for 30–120 minutes.

Equipment & techniqueUses pump systems, temperature‑controlled container, tubing for inflow/outflow, and peritoneal temperature monitoring; may be performed via open or closed techniques.

Indication contextUsed as an adjunct to cytoreductive surgery for selected peritoneal surface malignancies per guideline recommendations.

Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC)

Definition

Therapy Line and Clinical Context

informational

Informational: Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is classified as not medically necessary (experimental/investigational/unproven) for all indications; services in the context of a clinical trial are subject to the Plan's Clinical Trials policy and member benefits

Background and Rationale

Intraperitoneal hyperthermic chemotherapy (IPHC/HIPEC) is administered intraoperatively as an adjunct to cytoreductive surgery to circulate heated chemotherapy within the peritoneal cavity; by contrast, PIPAC delivers aerosolized chemotherapy laparoscopically under pressure. The current policy addition explicitly designates PIPAC as experimental/investigational/unproven for all indications and updates coding to capture PIPAC‑related procedure codes. Providers should note that HIPEC and IPHC remain addressed separately under indications supported by applicable guidelines.

Document Revision History

2026-08-01effective_dateLatest

Policy effective date updated to include PIPAC designation and coding changes; PIPAC added as experimental/investigational/unproven for all indications.

2026-05-13last_review

Policy last reviewed; background and references updated and policy scope/name revised to explicitly include PIPAC.

2026-02-01committee_review

Policy Summary

Payerpriority health

PolicyIntraperitoneal Chemotherapy (HIPEC/IPHC and PIPAC)

Policy CodePolicy 91548

Change TypeInclusion of PIPAC as E/I/Ucoding updates

Effective DateAug 1, 2026

Last ReviewMay 13, 2026

Next Review DateMay 13, 2026

Key ActionSubmit prior authorization requests where required and document medical necessity; use updated PIPAC-specific codes on authorization requests.

SourceLink

On This Page

Technique noteEither open or closed technique may be used; pump circulation maintains exposure duration

Note

No additional action stated

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Documentation Required

Provide documentation to demonstrate medical necessity with prior auth

Providers must submit prior authorization requests where required and demonstrate medical necessity; individual consideration for investigational treatments requires prior plan approval and review by a Priority Health medical director or clinical pharmacist.

Include clinical rationale and supporting documentation to demonstrate medical necessity.
Requests for investigational treatments require prior plan approval and will be reviewed by medical leadership.

Documentation Required

Document clinical trial participation and benefits applicability

Services provided as part of a clinical trial are governed by the Plan's Clinical Trials policy and member benefits; documentation should reference trial enrollment and applicability of member benefits.

Document clinical trial enrollment and indicate whether the Plan's Clinical Trials policy applies for the member.
Follow the Plan's Clinical Trials policy for coverage determinations on trial-related services.

Denial Risk

Obtain prior approval for experimental/investigational/unproven (E/I/U) treatments

Requests for experimental, investigational, or unproven treatments will be denied unless approved by a Priority Health medical director or clinical pharmacist; individual case review may allow coverage for investigational yet promising care with prior plan approval.

Obtain prior plan approval for E/I/U treatments to avoid denial.
Requests for exception require review and approval by medical leadership.

Denial Risk

PIPAC is treated as experimental/investigational/unproven

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is designated experimental/investigational/unproven for all indications and requests for PIPAC billed as standard‑of‑care will be subject to denial.

Do not bill PIPAC as standard‑of‑care without prior plan approval.
Seek prior plan approval and medical director review if requesting coverage for PIPAC in an individual case.

Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) is a laparoscopic technique that delivers chemotherapy as a pressurized aerosol into a closed abdominal cavity under capnoperitoneum pressure.

Delivery methodAdministered laparoscopically without extensive cytoreduction, using aerosolization under capnoperitoneum to improve drug distribution and tissue penetration.

Clinical intentDesigned to be repeatable and most often used for unresectable, recurrent, or chemotherapy‑refractory peritoneal metastases, frequently combined with systemic therapy.

PIPAC — Pressurized intraperitoneal aerosol chemotherapy

Technique descriptionPIPAC delivers aerosolized chemotherapy into the peritoneal cavity under pressure (capnoperitoneum) via laparoscopy to enhance distribution and penetration.

Indications per policyPolicy designates PIPAC as experimental/investigational/unproven for all indications (includes oxaliplatin, cisplatin/doxorubicin, and other agents).

RepeatabilityIntended to be repeatable and used often without extensive cytoreduction in palliative or bidirectional approaches.

HIPEC — Hyperthermic intraperitoneal chemotherapy (procedural descriptors)

DefinitionHIPEC is hyperthermic intraperitoneal chemotherapy administered intraoperatively following cytoreductive surgery to treat peritoneal surface malignancies by circulating heated chemotherapy solution throughout the abdomen.

Typical parametersCirculated volume commonly 3–5 L; infusate temperature typically 40–45°C with exposure 30–120 minutes.

RoleUsed as an adjunct to cytoreductive surgery for select tumor types and supported by disease‑specific literature and guideline recommendations.

Technique & equipmentPerformed using pump systems and temperature monitoring; may use open or closed techniques during intraoperative administration.

Policy underwent committee review (listed among past committee review dates).

2025-02-01committee_review

Policy underwent committee review (listed among past committee review dates).

2008-02-01committee_review

Initial/early committee review date recorded among past committee review dates.