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Blue Cross & Blue Shield of MississippiAll Plans · Coverage · Medical Policy · Oncology, RadiologyMedium impact

Radioembolization for Primary and Metastatic Tumors of the Liver

Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

The policy considers yttrium-90 microsphere radioembolization medically necessary for primary hepatocellular carcinoma that is unresectable and limited to the liver, as a bridge to liver transplantation, and for primary intrahepatic cholangiocarcinoma in individuals with unresectable tumors. It also considers radioembolization medically necessary for hepatic metastases from neuroendocrine tumors with diffuse and symptomatic disease when systemic therapy has failed to control symptoms. It may be considered medically necessary for unresectable hepatic metastases from colorectal carcinoma, melanoma (ocular or cutaneous), or breast cancer that are both progressive and diffuse, in individuals with liver-dominant disease who are refractory to chemotherapy or are not candidates for chemotherapy or other systemic therapies. Radioembolization is investigational for all other hepatic metastases and for all other indications not described.

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What to do

Action · 4 steps
01Billing team: Bill CPT 37243 and HCPCS S2095 only for radioembolization that meets the policy, since these codes are medically necessary only when the procedure is performed according to the policy section.
02Bill only when the diagnosis is one of the indications the policy covers, including ICD-10 codes C22.0, C22.1, C78.7 and C7B.02.
03Radioembolization should be reserved for individuals with Eastern Cooperative Oncology Group performance status 0 to 2, adequate liver function and reserve, Child-Pugh class A or B, and liver-dominant metastases, so document these characteristics.
04Keep documentation that supports medical necessity, because BCBSMS makes no payment for services that are not documented to be medically necessary.

Codes mentioned

37243S2095C22.0C22.1C78.7

Original notice

Radioembolization for Primary and Metastatic Tumors of the Liver
bcbsms.com · Always check the source before changing claims.
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Related changes

See all Blue Cross & Blue Shield of Mississippi changes →
Transcatheter Arterial Chemoembolization to Treat Primary or Metastatic Liver MalignanciesMediumNo effective date · Medical PolicyOncologic Applications of Photodynamic Therapy, Including Barrett EsophagusMediumNo effective date · Medical PolicyRadiofrequency Ablation of Primary or Metastatic Liver TumorsMediumNo effective date · Medical PolicyMicrowave Tumor AblationMediumNo effective date · Medical PolicyBrowse every Blue Cross & Blue Shield of Mississippi change in the policy list

Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesOncologyRadiologyCode 37243Code S2095Code C22.0Code C22.1Code C78.7

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