Does C9790 require prior authorization?

No, C9790 does not require prior authorization (high confidence). Code is covered without prior authorization.

`C9790`, Histotripsy (i.e., non-thermal ablation via acoustic energy delivery) of

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Technical success / early post-procedure imaging for investigational device: HistoSonics trial: "Following histotripsy treatment of liver tumor(s), subjects will undergo imaging less than or equal to 36 hours post-index procedure to determine technical success. Subjects will then be followed for 30 days."
Assessment of necrosis / efficacy timing in clinical reports: e.g., EUS-RFA authors compared CH-EUS (contrast harmonic EUS) performed >24 hours post-treatment vs CT at 30 days and recommended CT scan at 30 days for more accurate assessment of necrosis (de Nucci et al 2020).
Outcome measurement in clinical studies: many trials used CT or MRI and defined endpoints such as complete ablation on imaging at 1 month, recurrence-free survival, overall survival; e.g., Peng et al (2013): primary end point was OS, secondary was recurrence-free survival, tertiary was adverse effects; imaging follow-up 7–62 months.

Cryoablation / cryosurgery for liver tumors and colorectal liver metastases
Percutaneous MR-guided ablation of small (≤ 12 mm) hepatic malignancies
Cryosurgery, microwave, or radiofrequency ablation for members with isolated colorectal cancer liver metastases or isolated hepatocellular cancer who are not candidates for open surgical resection when the selection criteria specified below are met.
Members must either have hepatic metastases from a colorectal primary cancer or have a hepatocellular cancer.
Members must have isolated liver disease. Members with nodal or extra-hepatic systemic metastases are not considered candidates for these procedures.
All tumors in the liver, as determined by pre-operative imaging, would be potentially destroyed by cryotherapy, microwave, or radiofrequency ablation.

ANTHEM-CG-SURG-78, Locoregional Techniques for Treating Primary and Metastatic Liver Malignancies

AETNA-CPB-0274, Ablation of Hepatic Lesions

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