All PlansCoverageMedium impact
Hyperthermic Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic Malignancies
Blue Cross & Blue Shield of Mississippi·MS · Oncology, General Surgery, OB-GYN·Medical Policy
We identified it
Jun 20, 2026
Summary
New medical policy A.2.03.07 establishes coverage criteria for Hyperthermic Intraperitoneal Chemotherapy (HIPEC) with cytoreductive surgery. HIPEC is now considered medically necessary for pseudomyxoma peritonei, diffuse malignant peritoneal mesothelioma, and specific stage III ovarian/fallopian tube cancers meeting strict criteria. The procedure remains investigational for colorectal, gastric, and endometrial peritoneal carcinomatosis.
Action Required
Immediately: Billing team must review all HIPEC procedure claims to ensure they meet the new medical necessity criteria outlined in policy A.2.03.07. Establish prior authorization workflows for HIPEC procedures, requiring documentation of specific cancer types and staging criteria. Update encounter forms to capture required clinical details including cancer stage, surgical candidacy, and cytoreduction expectations. Claims not meeting the defined criteria will likely be denied as investigational.