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Microwave ablation (MWA) destroys tumors and soft tissue by using microwave energy to create thermal coagulation and localized tissue necrosis. A single microwave antenna or multiple antennas connected to a generator are inserted directly into the tumor or tissue to be ablated, and energy from the antennas generates friction and heat. MWA may be performed as an open procedure, laparoscopically, percutaneously, or thoracoscopically under image guidance (e.g., ultrasound, computed tomography [CT] or magnetic resonance imaging [MRI]) with sedation, or local or general anesthesia. MWA has been investigated for ablation of tumors and tissue for the treatment of many conditions including: hepatocellular carcinoma, colorectal cancer metastatic to the liver, renal cell carcinoma, renal hamartoma, adrenal malignant carcinoma, non-small cell lung cancer, intrahepatic primary cholangiocarcinoma, breast tumors, abdominal tumors, and other tumors not amenable to resection. This technique may also be referred to as microwave coagulation therapy.
Proposed advantages of MWA include improved local control and benefits common to any minimally invasive procedure (e.g., preserving normal organ tissue, decreasing morbidity, decreasing length of hospitalization). Potential complications of the procedure include those caused by heat damage to normal tissue adjacent to the tumor (e.g., intestinal damage during MWA of the kidney or liver), structural damage along the probe track (e.g., pneumothorax as a consequence of procedures on the lung), liver enzyme elevation, liver abscess, ascites, pleural effusion, diaphragm injury, and secondary tumors, if cancerous cells are seeded during probe removal.
Several MWA devices have been cleared for marketing by the U.S. Food and Drug Administration (FDA) through the 510(k) process. Covidien's Evident Microwave Ablation System has 510(k) clearance for soft tissue ablation of non-resectable liver tumors. The following devices have 510(k) clearance for MWA of (unspecified) soft tissue:
This policy does not address MWA for the treatment of splenomegaly, ulcers or as a surgical coagulation tool.
I. Microwave ablation may be considered MEDICALLY NECESSARY AND APPROPRIATE for the following indications:
II. Microwave ablation is considered EXPERIMENTAL/INVESTIGATIVE for treatment of all other primary and metastatic tumors including, but not limited to, the following:
No additional statements.
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Note that services with specific coverage criteria may be reviewed retrospectively to determine if criteria are being met. Retrospective denial of claims may result if criteria are not met.
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Acknowledgements:
CPT® codes copyright American Medical Association® 2022. All rights reserved.
CDT codes copyright American Dental Association® 2022. All rights reserved.