CommercialCoverageMedium impact
Radioembolization for Primary and Metastatic Tumors of the Liver
Blue Cross & Blue Shield of Mississippi·MS · Oncology, Gastroenterology, Radiology +1 more·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBS Mississippi updated their radioembolization policy for liver tumors, defining specific medical necessity criteria for primary hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and select metastatic cancers. The policy clarifies when radioembolization is considered medically necessary versus investigational.
Action Required
Immediately: Billing and clinical teams should review radioembolization cases to ensure they meet the specific medical necessity criteria outlined in policy A.8.01.43. Verify patients have unresectable tumors limited to liver, adequate liver function (Child-Pugh class A or B), and meet diagnosis-specific requirements. Document medical necessity thoroughly as cases not meeting criteria will be considered investigational and likely denied.