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MA07.017g, Hyperthermic Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic Malignancies
Effective date
Jun 16, 2025
Identified
Oct 2, 2026
Summary
Independence Blue Cross Medicare Advantage has expanded HIPEC (hyperthermic intraperitoneal chemotherapy) coverage to include peritoneal carcinomatosis of gastric origin as medically necessary (previously experimental). The policy also refined ovarian/fallopian tube cancer coverage headers and removed eight ICD-10 codes. Effective June 16, 2025, gastric peritoneal carcinomatosis claims now require specific criteria: PCI ≤10, no extraperitoneal metastasis, and expected complete cytoreduction.
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What to do
Action · 7 steps
01Before June 16, 2025: Billing team must update claim submission logic in the billing system to recognize gastric peritoneal carcinomatosis (ICD-10 codes beginning with C16) as medically necessary for HIPEC (CPT 96547, 96548) when accompanied by supporting documentation.
02Remove the eight deleted ICD-10 codes (C18.1, C56.1, C56.2, C56.3, C56.9, C57.00, C57.01, C57.02) from any existing coverage rules.
03Prior to claim submission, ensure medical records document: (1) Peritoneal Cancer Index (PCI) ≤10, (2) no evidence of extraperitoneal metastasis, and (3) surgeon expectation of complete cytoreduction.
04Flag gastric carcinomatosis claims for manual review if PCI documentation is absent or unclear.
05Claims submitted without these criteria will be denied.
06Update provider communication templates to reflect gastric origin as now covered.
07Oncology and surgical teams must be notified of the new medical necessity determination.
Codes mentioned
9654796548C45.1C48.0C48.1C48.2C48.8C78.6C18.1C56.1C56.2C56.3C56.9C57.00C57.01C57.02
Original notice
MA07.017g, Hyperthermic Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic Malignancies
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
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