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    v1.0.28
    OpenPayerPolicy UpdatesHematology/OncologySelect Health Tumor Treating Fields Update | OpenP…
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    CurrentSelect HealthPolicy CCP.1568

    Tumor Treating Fields for Pancreatic Cancer

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    Coverage determinations for tumor treating fields used to treat unresectable, locally advanced pancreatic cancer; the treatment is considered investigational/not clinically proven and not medically necessary.

    Policy Summary
    PayerSelect Health
    PolicyTumor Treating Fields for Pancreatic Cancer
    Policy CodePolicy CCP.1568
    Change TypeNo material change
    Effective DateOctober 1, 2026
    Last ReviewSep 1, 2026
    Next Review DateJanuary 1, 2028
    Key ActionDo not consider tumor treating fields medically necessary for unresectable, locally advanced pancreatic cancer.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    Not medically necessaryCoverage stance
    571PANOVA-3 participants
    ~2 months

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Overall survival gain
    76.3%Device-related skin events
    $1.0M/QALYCost-effectiveness ratio

    Coverage Criteria

    Not medically necessary

    Tumor treating fields for treatment of unresectable, locally advanced pancreatic cancer are not medically necessary.

    Not medically necessary: Tumor treating fields are investigational/not clinically proven for treatment of unresectable, locally advanced pancreatic cancer.

    The policy does not establish a covered clinical scenario for this service.

    Tumor treating fields for the treatment of unresectable, locally advanced pancreatic cancer are considered investigational/not clinically proven and are therefore not medically necessary. This service is excluded from coverage under the policy.

    Tumor treating fields used to treat unresectable, locally advanced pancreatic cancer are not medically necessary and are excluded from coverage as investigational/not clinically proven.

    Related Coding

    Related codesCPT
    1025TAlternating electric fields dosimetry and delivery-simulation modeling, creation and selection of patient-specific array layouts, and placement verification
    A4555Electrode/transducer for use with electrical stimulation device used for cancer treatment, replacement only
    E0766Electrical stimulation device used for cancer treatment, includes all accessories, any type

    Provider Guidance

    Denial Risk

    Tumor treating fields are not medically necessary

    Do not submit tumor treating fields for treatment of unresectable, locally advanced pancreatic cancer as a medically necessary covered service. The policy considers this treatment investigational/not clinically proven and therefore not medically necessary.

    Clinical Background

    Pancreatic adenocarcinoma arises from pancreatic duct cells and is the most common type of pancreatic cancer. Tumor treating fields, also called alternating electric fields, are low-energy, non-ionizing electrical fields intended to disrupt the ability of cancer cells to grow and divide. Optune Pax is a portable device that delivers 150 kHz fields to the abdomen through noninvasive transducer arrays. Evidence in pancreatic cancer is limited primarily to the manufacturer-sponsored PANOVA-3 trial, which reported a modest overall-survival gain and frequent device-related skin adverse events.

    Key Definitions

    Tumor treating fields
    Field typeLow-energy, non-ionizing electrical fields
    FunctionDisrupt the ability of cancer cells to grow and divide
    Optune Pax
    Device typePortable, wearable device
    Delivery frequency150 kHz
    Treatment siteAbdomen
    Delivery methodNoninvasive, electrically insulated transducer arrays connected to the device

    Treatment Line

    First-line

    The studied first-line treatment setting was tumor treating fields combined with chemotherapy.

    Front-line treatment: Tumor treating fields are used in combination with gemcitabine and nab-paclitaxel as front-line treatment of unresectable, locally advanced pancreatic adenocarcinoma.

    This describes the studied treatment setting and does not establish coverage.

    Treatment Regimen

    RegimenIndicationCoverage
    Tumor treating fields with gemcitabine and nab-paclitaxelUnresectable, locally advanced pancreatic adenocarcinomaNot covered
    Policy Summary
    PayerSelect Health
    PolicyTumor Treating Fields for Pancreatic Cancer
    Policy CodePolicy CCP.1568
    Change TypeNo material change
    Effective DateOctober 1, 2026
    Last ReviewSep 1, 2026
    Next Review DateJanuary 1, 2028
    Key ActionDo not consider tumor treating fields medically necessary for unresectable, locally advanced pancreatic cancer.
    SourceLink
    On This Page
    Coverage CriteriaRelated CodingProvider GuidanceClinical BackgroundKey DefinitionsTreatment LineTreatment Regimen
    Locally advanced pancreatic cancer
    DefinitionPancreatic cancer with local extension that prevents surgical resection