Electric Tumor Treatment Field Therapy (for Indiana Only)
Policy governing medical necessity and coverage considerations for electric tumor treatment field therapy (TTF) in the state of Indiana, including device, software, and applicable coding references; affects providers and members covered under UnitedHealthcare Indiana plans.
Revised language pertaining to medical necessity clinical coverage criteria and replaced reference to the InterQual Medicare criteria with InterQual Medicare: Post Acute & Durable Medical Equipment, Tumor Treatment Field Therapy (TTFT).
Updated list of applicable HCPCS codes to reflect quarterly edits and added code E0767.
Clarified that computer software used for therapeutic radiology clinical treatment planning in conjunction with electric TTF therapy is unproven and not medically necessary.
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