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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
Jun 19, 2026
Summary
Independence Blue Cross expanded coverage for HIPEC (hyperthermic intraperitoneal chemotherapy) by reclassifying gastric peritoneal carcinomatosis from experimental/investigational to medically necessary, effective June 16, 2025. The policy also clarified ovarian/fallopian tube cancer coverage and removed 8 ICD-10 codes that are no longer applicable to this procedure.
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What to do
by Jun 16, 2025 · 6 steps
01Billing team must update claims processing system to recognize gastric peritoneal carcinomatosis (ICD-10 codes for gastric cancer with peritoneal involvement) as medically necessary for HIPEC when three criteria are met: peritoneal cancer index ≤10, no extraperitoneal metastasis, and expected complete cytoreduction.
02Remove the 8 deleted ICD-10 codes from billing templates and validation rules.
03Update prior authorization workflows to route gastric carcinomatosis HIPEC cases as covered (not experimental) and require documentation of all three criteria before claim submission.
04Provider education: Ensure surgeons submit operative reports confirming PCI score, metastasis status, and cytoreduction feasibility.
05Verify that claims using CPT 96547/96548 with gastric cancer diagnoses are processed under covered (not denied as experimental) rules.
06Claims submitted without required documentation will still be subject to denial.
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 Policy11.00.13k, 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 PolicyBrowse every Independence Blue Cross change in the policy list