Cryosurgical ablation may be considered medically necessary to treat localized renal cell carcinoma that is no more than 4 cm in size when either of the following criteria is met:
Preservation of kidney function is necessary (ie, the patient has 1 kidney or renal insufficiency defined by a glomerular filtration rate of <60 mL/min/m2), and standard surgical approach (ie, resection of renal tissue) is likely to worsen kidney function substantially; or The patient is not considered a surgical candidate. Cryosurgical ablation may be considered medically necessary to treat lung cancer when either of the following criteria is met: The patient has early-stage non-small-cell lung cancer and is a poor surgical candidate; or The patient requires palliation for a central airway obstructing lesion. Cryosurgical ablation is considered investigational as a treatment for benign or malignant tumors of the breast, lung (other than defined above), pancreas, or bone and to treat renal cell carcinomas in patients who are surgical candidates.
