This policy has been updated to communicate the revised medical necessity criteria, including dosing and frequency requirements, which reflects the United States Food and Drug Administration (FDA) labeling and National Comprehensive Cancer Network (NCCN) compendia. Additionally, the coverage of non-preferred products has been further clarified.
The following indication was added to the policy: hepatocellular carcinoma (HCC)
The following indication was removed from this policy, in alignment with NCCN compendia: AIDS-related Kaposi's sarcoma.
The following indications were revised, per FDA or NCCN: - CNS Tumors
- Cerival Carcinoma
- Colon or Rectal Carcinoma
- Malignant Pleural Mesothelioma
- NSCLC
- Ovarian, Fallopian tube, or primary peritoneal cancer
- Vulvar Cancer
The following ICD-CM codes have been added to this policy:
C22.0 Liver cell carcinoma C22.1 Intrahepatic bile duct carcinoma C22.2 Hepatoblastoma C22.3 Angiosarcoma of liver C22.4 Other sarcomas of liver C22.7 Other specified carcinomas of liver C22.8 Malignant neoplasm of liver, primary, unspecified as to type C22.9 Malignant neoplasm of liver, not specified as primary or secondary
The following ICD-CM codes have been deleted from this policy:
C46.0 Kaposi's sarcoma of skin C46.1 Kaposi's sarcoma of soft tissue C46.2 Kaposi's sarcoma of palate C46.3 Kaposi's sarcoma of lymph nodes C46.4 Kaposi's sarcoma of gastrointestinal sites C46.50 Kaposi's sarcoma of unspecified lung C46.51 Kaposi's sarcoma of right lung C46.52 Kaposi's sarcoma of left lung C46.7 Kaposi's sarcoma of other sites C46.9 Kaposi's sarcoma, unspecified
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