Microwave ablation of primary or metastatic hepatic tumors may be considered medically necessary under the following conditions:
The tumor is unresectable due to location of lesion[s] and/or comorbid conditions
A single tumor of ≤5 cm or up to 3 nodules ≤3 cm each.
Microwave ablation of primary or metastatic lung tumors may be considered medically necessary under the following conditions:
The tumor is unresectable due to location of lesion and/or comorbid conditions
A single tumor of ≤3 cm.
Microwave ablation of more than a single primary or metastatic tumor in the lung is considered investigational.
Microwave ablation of primary or metastatic tumors other than liver or lung is considered investigational.
