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Intraperitoneal hyperthermic chemotherapy (IPHC) is used as an adjunct to surgery for the treatment of gastrointestinal, appendiceal, ovarian, or mesothelial cancers that have penetrated or metastasized into the peritoneal cavity. The goal of IPHC is to enhance the cytotoxic effect of chemotherapeutic drugs and thereby kill disseminated tumor cells and reduce the risk of tumor recurrence.
POLICYCytoreduction and hyperthermic intraperitoneal chemotherapy for the treatment of peritoneal carcinomatosis of gastrointestinal origin 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 HISTORY8/2001: Approved by Medical Policy Advisory Committee (MPAC)
2/13/2002: Investigational definition added
5/1/2002: Type of Service and Place of Service deleted
5/29/2002: Code Reference section completed
2/6/2007: Policy reviewed, no changes
9/20/2007: Code Reference section updated. ICD-9 2007 revisions added to policy
4/23/2009: Policy reviewed, no changes
10/6/2009: Code reference section updated. New ICD-9 diagnosis code 209.74 added to non-covered table.
SOURCE(S)Blue Cross Blue Shield Association policy # 2.03.07
Hayes Medical Technology Directory
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.