Anthem Blue Cross Connecticut Commercial Clinical Policy

Anthem Blue Cross Connecticut SURG.00159 Focal Laser Ablation for the Treatment of Prostate Cancer Form

Effective Date

04/12/2023

Last Reviewed

02/16/2023

Original Document

  Reference



This document addresses the use of focal laser ablation, also known as laser interstitial therapy or laser interstitial photocoagulation, to treat localized prostate cancer. The procedure is frequently performed with real-time MR imaging which also allows the use of MR thermometry to monitor the lesion and surrounding tissue during treatment.

Note: Please see the following related documents regarding other minimally invasive treatments of prostate cancer:

  • CG-MED-81 Ultrasound Ablation for Oncologic Indications
  • CG-SURG-61 Cryosurgical, Radiofrequency, Microwave or Laser Ablation to Treat Solid Tumors Outside the Liver

Position Statement

Investigational and Not Medically Necessary:

Focal laser ablation is considered investigational and not medically necessary for the treatment of prostate cancer.

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