Ablation of Hepatic Lesions (CPB 0274, reviewed 2026-06-08)

By 2026-06-08: Billing team must update authorization and claims processing workflows to enforce strict medical necessity criteria for hepatic ablation procedures. (1) Before submitting claims for CPT 47370, 47380, 47381, 47382, 47383, update billing system to require documented verification that: patient has isolated colorectal metastases OR hepatocellular carcinoma with NO nodal/extrahepatic metastases; all liver tumors are ≤4 cm diameter; liver involvement is <50% parenchyma; patient is unsuitable for open surgical resection. (2) Do NOT cover CPT 47382, 47383 or HCPCS 0600T, 0601T for any indication not explicitly listed as medically necessary (e.g., non-colonic metastases, palliative treatment, hepatic hemangioma, hepatic adenoma). (3) Flag and deny claims using CPT 0944T (3D contour simulation), 0686T (histotripsy), C9734 (HIFU+TACE combination), and 37242 for hepatic lesions—these remain experimental. (4) For CPT 75894 and 37243, only approve when treating hepatocellular carcinomas per coverage criteria. (5) Update encounter forms and provider education materials to clarify that microwave ablation for benign lesions and no-touch radiofrequency ablation are non-covered. (6) Establish pre-authorization protocol requiring operative reports and imaging confirmation of lesion size/location. Claims lacking documentation of medical necessity criteria will be denied.