Transcatheter arterial chemoembolization of the liver may be considered medically necessary:
to treat hepatocellular cancer that is unresectable but confined to the liver and not associated with portal vein thrombosis and liver function not characterized as Child-Pugh class C
as a bridge to transplant in patients with hepatocellular cancer where the intent is to prevent further tumor growth and to maintain a patient’s candidacy for liver transplant (see Policy Guidelines section)
to treat liver metastasis in symptomatic patients with metastatic neuroendocrine tumor whose symptoms persist despite systemic therapy and who are not candidates for surgical resection
to treat liver metastasis in patients with liver-dominant metastatic uveal melanoma.
Transcatheter arterial chemoembolization of the liver is considered investigational:
as neoadjuvant or adjuvant therapy in hepatocellular cancer that is considered resectable
as part of combination therapy (with radiofrequency ablation) for resectable or unresectable hepatocellular carcinoma
to treat unresectable cholangiocarcinoma
to treat liver metastases from any other tumors or to treat hepatocellular cancer that does not meet the criteria noted above, including recurrent hepatocellular carcinoma
to treat hepatocellular tumors prior to liver transplantation except as noted above.
