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Hyperthermia can be administered using local and whole body techniques.
Local hyperthermia entails elevating the temperature of superficial or subcutaneous tumors while sparing surrounding normal tissue, using either external or interstitial modalities.
Whole body hyperthermia requires the patient to be placed under either general anesthesia or deep sedation. The patient's body temperature is increased to 108° F by packing the patient in heat (hot water) blankets. The elevated body temperature is maintained for a period of four hours while the essential body functions are closely monitored. Approximately one hour is required for a "cooling off" period after which the patient is constantly observed for a minimum of twelve hours. This modality has been variously termed "systemic thermotherapy" or "whole body hyperthermia."
Local hyperthermia therapy may be considered medically necessary when used in combination with radiation therapy for the treatment of patients with primary or metastatic cutaneous or subcutaneous superficial tumors.
Local hyperthermia is considered investigational when used alone or in combination with chemotherapy.
Whole body hyperthermia is considered investigational.
Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
POLICY HISTORY3/1993: Issued
3/29/2001: Policy reviewed; Managed Care Requirements deleted, Code Reference section, Source(s) and Type of Service updated
2/14/2002: Investigational definition added
5/1/2002: Type of Service and Place of Service deleted
9/20/2002: Policy reviewed; no changes
1/17/2003: Policy reviewed; no changes based on Hayes report
2/13/2004: Code Reference section updated, ICD-9 procedure code range 92.21-92.26 deleted
2/20/2006: Code Reference table updated, CPT code 77620 added
2/24/2006: Policy reveiwed; no changes
7/18/2008: Anesthesia Coding Policy hyperlink added
9/28/2009: Coding Section updated with New ICD-9 Diagnosis Codes for 10-1-2009 added to Covered Codes Table- 209.31, 209.32, 209.33, 209.34, 209.35, 209.36, Verbiage added to Covered Codes Table, "* Some covered procedure codes may have multiple descriptions. Coverage will only be made for covered codes when used for services outlined within the policy statement section."
08/28/2015: Code Reference section updated for ICD-10. Extended ICD-9 diagnosis codes 173.0-173.9 to the fifth digit.
10/09/2015: Code Reference section updated to make the following correction: ICD-10 procedure code DWY48ZZ changed to DWY68ZZ.
SOURCE(S)Uniform Medical Policy Manual (11/1989)
Hayes Medical Technology Directory
Blue Cross Blue Shield Association policy #2.01.05
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document.
For Coding Guidelines see the Anesthesia Coding Policy.