CMS National Coverage Determination (NCD)

CMS Therapeutic Embolization Form



Therapeutic Embolization for Hemorrhage

Notes: The procedure must be reasonable and necessary for the individual patient.

Indications

(954418) Is the therapeutic embolization procedure being performed to treat a hemorrhage? 

Renal Embolization for Renal Adenocarcinoma

Notes: Coverage has been effective since December 15, 1978. The procedure must be reasonable and necessary for the individual patient.

Indications

(954419) Is renal embolization being done to reduce tumor vascularity preoperatively? 
(954420) Is the renal embolization conducted to reduce tumor bulk in inoperable cases? 
(954421) Is the procedure intended to palliate specific symptoms? 

Therapeutic Embolization for Other Conditions

Notes: Specific indications beyond hemorrhage and renal adenocarcinoma require clarity on what conditions are amenable; the procedure must also be reasonable and necessary for the individual patient.

Indications

(954422) Is the therapeutic embolization being done for conditions other than hemorrhage that are amenable to treatment by the procedure? 

Effective Date

12/15/1978

Last Reviewed

NA

Original Document

  Reference



Therapeutic embolization is covered when done for hemorrhage, and for other conditions amenable to treatment by the procedure, when reasonable and necessary for the individual patient. Renal embolization for the treatment of renal adenocarcinoma continues to be covered, effective December 15, 1978, as one type of therapeutic embolization, to:

  • Reduce tumor vascularity preoperatively;
  • Reduce tumor bulk in inoperable cases; or
  • Palliate specific symptoms.