CommercialCoverageMedium impact
Hyperthermia in Cancer Therapy (CPB 0278, reviewed 2026-05-20)
Aetna·Oncology, General Surgery, Radiation Oncology +1 more·Medical Policy
Effective date
May 20, 2026
We identified it
Aug 18, 2026
Summary
Aetna updated its hyperthermia cancer therapy policy (CPB 0278) to specify which hyperthermia procedures are medically necessary versus experimental. The policy covers specific HIPEC procedures for mucinous carcinoma peritonei, peritoneal mesothelioma, goblet cell carcinoid, and ovarian cancer, plus regional hyperthermic melphalan perfusion for stages II, IIIA, and III extremity melanoma. All other hyperthermia indications—including deep hyperthermia, HIPEC for appendiceal/gastric/pancreatic/bladder cancers, and pleural HIPEC—are deemed experimental and not covered.
Action Required
By 2026-05-20: Billing team must update system rules to require prior authorization verification for HIPEC procedures (CPT 96547, 96548) and regional hyperthermic melphalan perfusion (CPT 77600) ONLY for the covered indications listed in the policy. Create a coverage validation checklist requiring ICD-10 diagnosis codes to match approved conditions (C45.1 peritoneal mesothelioma, C48.0-C48.8 peritoneal malignancies with MCP/mesothelioma only, C56.1-C56.9 stage III ovarian cancer, C7A.020-C7A.029 goblet cell carcinoid, C43.0-C44.99 melanoma stages II-III). All hyperthermia claims for non-approved indications (C16.0-C16.9 gastric cancer, C25.0-C25.9 pancreatic cancer, C67.0-C67.9 bladder cancer, C37 thymic carcinoma, C45.0 pleural mesothelioma, C78.2 pleural secondary malignancy, and CPT 77605/77610/77615/77620/96440) must be flagged as experimental and denied or routed for appeal. Update encounter templates and pre-authorization forms to include diagnosis verification. Communicate to oncology and surgical teams the specific approved indications. Non-compliance will result in claim denials and potential audit liability.