C9790 Insurance Policy Changes

Ablation of Hepatic Lesions (CPB 0274, reviewed 2026-06-08)

Aetna updated its Clinical Policy Bulletin 0274 on hepatic lesion ablation (effective 2026-06-08), clarifying coverage criteria for cryosurgery, microwave, and radiofrequency ablation procedures. The policy specifies strict medical necessity requirements including isolated liver disease, tumor size ≤4 cm, liver involvement <50%, and patient unsuitability for open surgical resection. Multiple ablation techniques and indications remain classified as experimental/investigational, requiring billing teams to verify eligibility before claim submission.