Electric Tumor Treatment Fields (CPB 0827, reviewed 2026-02-18)

Effective immediately (policy dated 2026-02-18): Billing team must implement mandatory prior authorization for CPT 1025T, HCPCS E0766, A4555, J8700, and J9328 when billed with ICD-10 codes C71.0–C71.9. Update billing system rules to require documentation of all 8 selection criteria before claim submission: (1) WHO grade IV astrocytoma histology confirmation, (2) maximal debulking surgery completion, (3) prior chemotherapy and radiotherapy completion, (4) initiation within 7 weeks of last chemo/radiation, (5) no disease progression per RANO criteria, (6) Karnofsky Performance Score ≥70, (7) patient age ≥22 years, (8) non-pregnant status (women of childbearing age) and no intracranial shunt/implanted device. Add mandatory 60–91 day re-evaluation requirement in billing workflow to flag claims for re-authorization every 90 days thereafter with evidence of ≥18 hours/day therapy adherence. Deny and return any claims for ETTF with ICD-10 codes outside C71.0–C71.9 range (e.g., C50.x breast cancer, C34.x lung cancer, C25.x pancreatic cancer, C45.0 mesothelioma, C79.31 brain metastases) as experimental/not covered. Update provider templates to ensure treating practitioners document clinical re-evaluation and objective adherence data for all continuation claims. Failure to enforce these controls will result in claim denials and potential recovery actions.