All PlansCoverageHigh impact
Thermal Ablation for Solid Tumor Treatment 7.01.111
Excellus BlueCross BlueShield·Oncology, General Surgery, Radiology +2 more·Cancer Treatment (Oncology)
Effective date
Aug 21, 2025
We identified it
Jun 20, 2026
Summary
New comprehensive policy establishes coverage criteria for thermal ablation procedures (radiofrequency, cryosurgical, and microwave ablation) for various solid tumors including liver, lung, kidney, bone, and uterine cancers. The policy defines specific medical appropriateness criteria based on tumor size, location, and patient surgical candidacy.
Action Required
By August 21, 2025: Billing team must review and implement new coverage criteria for thermal ablation procedures. Update prior authorization requirements to verify patients meet specific criteria including tumor size limits (typically 3-5cm), surgical candidacy status, and Milan criteria for liver tumors. Train staff on documentation requirements for tumor type, size, location, and rationale for non-surgical treatment. Claims may be denied if medical appropriateness criteria are not met and documented.