National Coverage Analysis (NCA) Tracking Sheet

Liver Transplantation for Malignancies

CAG-00091R

Issue

In 2001, Medicare established coverage for adult liver transplantation in beneficiaries with hepatocellular carcinoma when the following conditions are met:

  • The patient is not a candidate for subtotal liver resection;
  • The patient's tumor(s) is less than or equal to 5 cm in diameter;
  • There is no macrovascular involvement;
  • There is no identifiable extrahepatic spread of tumor to surrounding lymph nodes, lungs, abdominal organs or bone; and
  • The transplant is furnished in a facility that is approved by CMS as meeting institutional coverage criteria for liver transplants (See 65 FR 15006).

Currently, adult liver transplantation for other malignancies remains excluded from coverage.

CMS is opening this analysis to review new evidence on the impact on health outcomes of liver transplantation in beneficiaries who have malignancies. We would be especially interested in evidence related to liver transplantation in patients who have cholangiocarcinoma or neuroendocrine/gastroenteropancreatic (GEP) tumors.

National Coverage Determinations

Benefit Category

Inpatient Hospital Services
Physicians' Services

Requestor Information

Requestor Name Requestor Letter
Internally generated request N/A
N/A

Important Dates

Formal Request Accepted and Review Initiated
10/14/2011
Expected NCA Completion Date
06/27/2012
Public Comment Period
10/14/2011 - 11/13/2011
Proposed Decision Memo Due Date
Proposed Decision Memo Released
03/29/2012
Proposed Decision Memo Public Comment Period
03/29/2012 - 04/28/2012
Decision Memo Released
06/21/2012
Comments for this NCA
View Public Comments

Contacts

Lead Analysts
Roya D Lotfi
Lead Medical Officers
Lori Paserchia, M.D.

Medicare Benefit Category Determination Date

Actions Taken

October 14, 2011

Internally generated national coverage analysis (NCA). Initial 30 day public comment period begins. After considering the public comments and reviewing relevant evidence, we will release a proposed decision memorandum. Instructions for submitting public comments can be found at http://www.cms.hhs.gov/Medicare/Coverage/InfoExchange/publiccomments.html#TopOfPage

March 29, 2012

June 21, 2012