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11.00.13k, Hyperthermic Intraperitoneal Chemotherapy for Select Intra-abdominal and Pelvic Malignancies
Act
by Jun 16, 2025
Effective date
Jun 16, 2025
Identified
Oct 2, 2026
Summary
Independence Blue Cross expanded coverage for hyperthermic intraperitoneal chemotherapy (HIPEC) by reclassifying peritoneal carcinomatosis of gastric origin from experimental/investigational to medically necessary, effective June 16, 2025. The policy also clarified coverage headers for ovarian, fallopian tube, and primary peritoneal cancers, and removed 8 ICD-10 diagnosis codes from the policy document.
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What to do
by Jun 16, 2025 · 6 steps
01Billing team must update prior authorization system to approve HIPEC claims (CPT 96547, 96548) for gastric peritoneal carcinomatosis when all criteria are met (PCI ≤10, no extraperitoneal metastasis, expected complete cytoreduction).
02Update billing software to recognize that gastric peritoneal carcinomatosis claims are now medically necessary rather than experimental/investigational.
03Remove the 8 deprecated ICD-10 codes (C18.1, C56.1, C56.2, C56.3, C56.9, C57.00, C57.01, C57.02) from billing templates and system defaults.
04Ensure surgeons and surgical teams document PCI score, extraperitoneal metastasis status, and expected cytoreduction success in operative reports to support medical necessity for claims.
05Audit pending or denied claims for gastric peritoneal carcinomatosis HIPEC procedures from the past 12 months and resubmit with updated coverage determination.
06Claims submitted after June 16, 2025 without proper documentation of the three required criteria will be denied.
Codes mentioned
9654796548C45.1C48.0C48.1C48.2C48.8C78.6
Original notice
11.00.13k, Hyperthermic Intraperitoneal Chemotherapy for Select Intra-abdominal and Pelvic Malignancies
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
See all Independence Blue Cross changes →MA07.017g, Hyperthermic Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic MalignanciesMediumEffective Jun 16, 2025 · Medical PolicyMA07.017g, Hyperthermic Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic MalignanciesMediumEffective Jun 16, 2025 · Medical Policy11.00.13k, Hyperthermic Intraperitoneal Chemotherapy for Select Intra-abdominal and Pelvic MalignanciesMediumEffective Jun 16, 2025 · Medical PolicyBrowse every Independence Blue Cross change in the policy list