These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.
Electric tumor treatment fields (ETTF) therapy is generally covered subject to the indications listed below and per your plan documents.
Electric tumor treatment fields (ETTF) therapy is covered as follows:
- For patients with glioblastoma (GBM) that recurs or progresses after initial treatment; or
- As a treatment for adult patients (22 years of age or older) with histologically-confirmed glioblastoma multiforme (GBM) in combination with temozolomide; or
- For the treatment of adult patients with newly diagnosed, supratentorial glioblastoma following maximal debulking surgery, and completion of radiation therapy together with concomitant standard of care chemotherapy; or
- For the treatment of recurrent GBM following histologically-or radiologically-confirmed recurrence in the supratentorial region of the brain after receiving chemotherapy. The device is intended to be used as a monotherapy, and is intended as an alternative to standard medical therapy for GBM after surgical and radiation options have been exhausted.
Electric tumor treatment fields (ETTF) is not covered for any additional indications.
Tumor treating fields (TTFs) therapy uses alternating electric fields to inhibit cell proliferation and lead to programmed cell death. TTF therapy targets dividing cells to stop tumor growth while sparing normal tissue. The Optune™ TTF system is intended to treat patients with glioblastoma by using transducer arrays placed on the patient’s scalp according to the tumor’s location. Patients use the device on an outpatient basis for at least 18 hours per day for 4 weeks to several months. Intended benefits include stabilizing the disease, having fewer treatment-related adverse events, and improving quality of life.
If available, codes for a procedure, device or diagnosis are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all inclusive.
Electrical stimulation device used for cancer treatment, includes all accessories, any type
Electrode/transducer for use with electrical stimulation device used for cancer treatment, replacement only
CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.
- ECRI Emerging Technology Report. “Tumor treating fields therapy (NovoTTF-100A) for recurrent glioblastoma.” Nov 2015
- Stupp et al. “NovoTTF-100A versus physician's choice chemotherapy in recurrent glioblastoma: a randomized phase III trial of a novel treatment modality.” Eur J Cancer. 2012 Sep;48(14):2192-202. doi: 10.1016/j.ejca.2012.04.011. Epub 2012 May 18.
- Stupp et al. “Maintenance therapy with tumor-treating fields plus temozolomide vs temozolomide alone for Glioblastoma: a randomized clinical trial.” JAMA.2015;314(23) 2535-2543.