Modifiedpriority healthPolicy N/A

Intraperitoneal Hyperthermic Chemotherapy (IPHC/HIPEC)

This policy outlines coverage criteria, coding, regulatory and guideline references for intraperitoneal hyperthermic chemotherapy (IPHC/HIPEC) as an adjunct to cytoreductive surgery for peritoneal malignancies and applies to Priority Health members subject to their plan benefits.

Policy Summary

Payerpriority health

PolicyIntraperitoneal Hyperthermic Chemotherapy (IPHC/HIPEC)

Policy CodePolicy N/A

Change TypeAdded scope and guideline/regulatory sectionsupdated references

Effective DateMar 1, 2026

Next Review Date

Key ActionWhen prior authorization is required, submit documentation demonstrating medical necessity and reference applicable NCCN guidelines.

SourceLink

POLICY UPDATE CHANGES

New Policy Scope, FDA/Regulatory, Medical/Professional Society Guidelines, and Government Regulations sections were added.

Background and references were updated.

4NCCN tumor types cited

40-45°CTypical temp range (°C)

30-120Exposure duration (min)

2CPT codes listed

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Guideline/society sources

02/2026Document maintenance history

Coverage Criteria for IPHC/HIPEC

Medical Necessity Criteria

Covered when ONE of the following is met:

NCCN-recommended indications: IPHC/HIPEC may be covered when recommended by the NCCN Guidelines for specified tumor types (Colon Cancer; Gastric Cancer; Peritoneal Mesothelioma; Ovarian Cancer including epithelial/fallopian tube/primary peritoneal).

References to NCCN versions provided in guideline section.

Clinical trial coverage: IPHC/HIPEC not recommended by NCCN may be covered as part of a clinical trial when the criteria of the Clinical Trials medical policies #91606 or #91448 are met and prior plan approval obtained.

See related policies for clinical trial requirements.

Evidence citations (informational)

Evidence and guideline references relevant to coverage decisions

Evidence and guideline citations (informational): Selected references and guideline citations relevant to IPHC/HIPEC coverage decisions include NCCN guideline versions and supporting literature for Colon Cancer, Gastric Cancer, Ovarian Cancer, and Peritoneal Mesothelioma as listed below; these references inform the policy criteria and documentation expectations.

See full reference list in guideline/reference section of the policy.

Coverage for treatments that are classified as experimental, investigational, or unproven is excluded unless an approved exception is obtained. Individual case review may allow coverage for investigational yet promising care, but such requests require prior plan approval and a determination by a Priority Health medical director or clinical pharmacist. Exceptions may be considered when the condition is a terminal illness or a chronic, life‑threatening, severely disabling disease causing serious clinical deterioration.

No explicit exclusion criteria beyond the experimental/investigational exception language are stated in the cited material. The referenced sections instead provide bibliographic citations and literature supporting clinical context and practice for CRS/HIPEC rather than additional exclusion rules.

Treatments described as experimental, investigational, or unproven are generally not covered under this policy unless an exception is approved following prior plan approval. Requests for individual consideration must be submitted for review, and all determinations for such exceptions are made by a Priority Health medical director or clinical pharmacist.

Within the provided reference material there are no explicit statements using the phrase "not medically necessary" to describe services. The document instead focuses on coverage conditions, exception review processes, and literature citations relevant to CRS/HIPEC.

Coding and Procedure Codes

Covered CPT/HCPCS Codes and coding notesCPTCovered

96547	Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure; first 60 minutes (List separately in addition to code for primary procedure)
96548	Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure; each additional 30 minutes (List separately in addition to code for primary procedure)
96446	Chemotherapy administration into the peritoneal cavity via implanted port or catheter (coding note: identifies administration via implanted port or catheter; distinct from external intraoperative HIPEC)

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/ICD-10 codesmixed

No codes listed

Peritoneal infusate temperature — inv-10

Typical peritoneal infusate temperatureTypically maintained between 40 and 45°C (104–113°F)

Volume of perfusateTypically 3–5 L circulated using temperature‑controlled container and pumps

Technique variabilityEither open or closed HIPEC technique may be used; no universal standard for temperature

Exposure duration — inv-11

Typical exposure durationTypically ranges from 30 to 120 minutes

Procedure timingExposure occurs immediately following cytoreductive surgery during intraoperative circulation

Provider Actions, Authorization, and Documentation

Prior Authorization

Prior Authorization Required

Prior authorization for certain drugs, devices, services and procedures may be required. When prior authorization is required, providers must submit a request demonstrating that the drug, service, or procedure is medically necessary. For more information and specific prior authorization processes, providers should refer to the Priority Health Provider Manual.

Submit medical necessity documentation when prior authorization is required.
Refer to the Priority Health Provider Manual for prior authorization processes and requirements.

Denial Risk

Denial Risk for Experimental or Unproven Treatments

Requests for coverage of experimental, investigational, or unproven treatments may be denied unless an exception is approved by Priority Health. Individual case review may allow coverage for investigational yet promising care in select circumstances; such requests require prior plan approval and are decided by a Priority Health medical director or clinical pharmacist. Exception review may be considered when the condition is a terminal illness or a chronic, life‑threatening, severely disabling disease causing serious clinical deterioration.

Background and Context

Intraperitoneal hyperthermic chemotherapy (IPHC/HIPEC) is an intraoperative adjunct to cytoreductive surgery in which a heated chemotherapeutic solution is circulated within the peritoneal cavity to enhance the cytotoxic effect against residual tumor cells. Typical procedures use several liters of infusate circulated with pumps and tubing, with peritoneal temperatures typically maintained between 40 and 45°C and exposure durations that typically range from 30 to 120 minutes. Techniques may be performed using open or closed approaches as part of cytoreductive surgery for peritoneal surface malignancies.

Definitions

Definition — Intraperitoneal hyperthermic chemotherapy (IPHC/HIPEC) — inv-22

DefinitionIntraperitoneal hyperthermic chemotherapy (IPHC/HIPEC) is the intraoperative circulation of a heated chemotherapy solution in the peritoneal cavity immediately following cytoreductive surgery to enhance cytotoxicity against peritoneal tumor cells.

MechanismHeated sterile solution (typically 3–5 L) is circulated using pumps, tubing and temperature‑controlled containers with peritoneal temperature probes.

TechniqueMay be performed using open or closed techniques; heat and direct chemotherapeutic contact increase tumor cell kill.

Definition — Peritoneal carcinomatosis / peritoneal surface malignancy — inv-23

DefinitionPeritoneal carcinomatosis / peritoneal surface malignancy: malignant dissemination of tumor cells across peritoneal surfaces, commonly from colorectal, appendiceal, gastric, ovarian primaries, or mesothelioma, considered for cytoreductive surgery and intraperitoneal chemotherapy.

Covered Chemotherapeutic Regimens and Protocols

Reference / Society	Document / Guideline name	Scope or topic
NICE (UK)
Cytoreduction surgery with hyperthermic intraoperative peritoneal chemotherapy — NICE guidance
National guidance on CRS with intraoperative peritoneal chemotherapy; included among referenced position statements.

Citation	Study / Source	Key regimen or finding referenced
Fagotti A et al., Gynecol Oncol 2011
HIPEC in recurrent ovarian cancer: morbidity and long-term outcome analysis
Examines HIPEC application in recurrent ovarian cancer and associated morbidity/outcomes; cited among ovarian HIPEC literature.

Policy Summary

Payerpriority health

PolicyIntraperitoneal Hyperthermic Chemotherapy (IPHC/HIPEC)

Policy CodePolicy N/A

Change TypeAdded scope and guideline/regulatory sectionsupdated references

Effective DateMar 1, 2026

Next Review Date

Key ActionWhen prior authorization is required, submit documentation demonstrating medical necessity and reference applicable NCCN guidelines.

SourceLink

On This Page

Duration standardizationNo universally accepted standard for duration; published reports cite 30–120 minutes

None specified — inv-12

Specified thresholdsNone specified in this policy section

ImplicationWhen thresholds are not specified, refer to institution-specific protocols or cited literature for procedural parameters

DocumentationProviders should document clinical rationale and referenced guideline or trial when deviating from typical parameters

All determinations for experimental/investigational/unproven treatments are made by a Priority Health medical director or clinical pharmacist.
Exception requests require prior plan approval and will be reviewed on a case‑by‑case basis.
Exceptions may be considered for terminal illness or severe, progressive disease causing serious clinical deterioration.

Documentation Required

Guideline‑Based Documentation

When documenting medical necessity, providers should reference applicable clinical practice guidelines and supporting literature (for example, NCCN guidelines cited in this policy) to substantiate indications, patient selection, and expected clinical benefit. Documentation should align with the member's specific benefit terms and any group‑specific policy provisions.

Include guideline citations and relevant clinical evidence to support the request.
Ensure documentation demonstrates patient meets any guideline‑based selection criteria.
Verify that requested services are consistent with the member's plan benefits and any group‑specific rules.

Step Therapy

No step therapy requirements are specified in the source content for this policy. Providers should follow any plan‑specific step therapy rules if present in the member's benefit documents; absent plan guidance, no step therapy restrictions are imposed by this policy.

This policy does not define or impose step therapy requirements.
Consult the member's benefit documents for any plan‑specific step therapy rules.

Note

Apply Product‑Specific Rules

Coverage is subject to the member's specific benefits; group‑specific policy will supersede this policy when applicable. For self‑funded (ASO), Medicare, Medicaid/Healthy Michigan Plan, HMO/EPO, POS, PPO, and Individual products, providers must consult the applicable plan documents for coverage determinations and any differences in prior authorization or documentation requirements.

Check the member's product type and plan documents for benefit‑specific rules.
When there is a conflict between this policy and an applicable plan document, the plan document governs.

Common primariesColorectal, appendiceal, gastric, ovarian cancers and peritoneal mesothelioma frequently underlie peritoneal surface malignancy.

Clinical contextConsidered for cytoreductive surgery (CRS) with or without IPHC/HIPEC based on selection criteria and guideline recommendations.

Definition — Diffuse malignant peritoneal mesothelioma (DMPM) — inv-24

DefinitionDiffuse malignant peritoneal mesothelioma (DMPM) is a primary peritoneal malignancy of mesothelial origin discussed in systematic reviews and as a selection indication for cytoreductive surgery and HIPEC.

Evidence baseSystematic reviews and observational series (e.g., Baratti et al., 2011) and NCCN mesothelioma guidelines address CRS/HIPEC in DMPM.

Patient selectionSelection criteria (e.g., Ki‑67, extent of disease, exploratory laparoscopy) are reported in the literature to identify optimal candidates for CRS/HIPEC.