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Cancer Diagnosis, Staging and Management 2023-01-02T13:02:25-05:00

Cancer Diagnosis, Staging and Management

These are the AT&T CarePlus covered procedures and services effective January 1, 2023. Prior approval is required, please contact CarePlus customer care at 1-877-261-3340.

Active Breathing Control (ABC)
As adjunct to radiation therapy for breast and lung cancer.

Active Immunotherapy and/or Vaccines
For treatment of the following:

  • Melanoma
  • Non-Small Cell Lung Cancer
  • Ovarian Cancer
  • Prostate Cancer
  • Renal Cell Carcinoma
  • Glioblastoma Multiform
  • Other Cancers


Allogeneic Stem Cell
Including stem cells derived from bone marrow, peripheral blood, umbilical cord blood, ex vivo expanded cord blood or more than one umbilical cord blood, i.e., “double cord” transplant w/HDC.

  • Advanced Renal Cell Carcinoma
  • Advanced Melanoma
  • Breast Cancer
  • Bony/Soft Tissue Sarcoma
  • Systemic Mastocytosis
  • Neuroblastoma

Autologous Stem Cell (including Bone Marrow) Transplant
Includes stem cells derived from bone marrow, peripheral blood, umbilical cord blood, ex vivo expanded cord blood transplant w/HDC (for cancer).

  • Breast Cancer
  • Brain Cancer (Pediatric): Medulloblastoma, Pinealoma and others
  • Desmoplastic Small Round Cell Tumor
  • Fibrosarcoma
  • Osteosarcoma

Brachytherapy
For treatment of malignant brain tumors.

Circulating Tumor Cell Assay

Computer-Controlled, Multi-Spectral Dermoscopy
For example Melafind®. To detect and evaluate potentially malignant and pre-malignant dermal lesions.

Confocal Endomicroscopy
To detect and evaluate malignant and pre-malignant cells during standard esophagoscopy.

DelCATH Percutaneous Hepatic Perfusion (PHP) System
For delivering high-dose melphalan chemotherapy to treat liver tumors.

EarlyCDT®-Lung Screening Blood Test
For early detection of lung cancer.

Electromagnetic Navigational Bronchoscopy (Covered only for participants who do not have coverage for this service under their Base Medical Program)
For enhanced visualization of lung lesions.

Emerging Treatments or Therapies
For cancer and other severe, life-threatening diseases when:

  • Conducted pursuant to an FDA, NIH, NCI, or Cancer-cooperative group approved Phase I, II or Phase III Clinical Trial. In the event a covered person is not formally a participant in the approved clinical trial, such treatment or therapy must be administered under the direction of a doctor, follow the protocols and procedures utilized in the trial and be delivered at a facility that has been designated as a participant under the approved FDA, NIH, NCI, or Cancer-cooperative group for Phase I, II or Phase III Clinical Trial.
  • Where the illness is encountered so infrequently that no formal trials exist, if the proposed treatment is considered promising care by knowledgeable experts in the field and is supported by evidence of efficacy in the peer-reviewed literature, such treatment will be allowed when performed within a facility that actively participates in approved FDA, NIH, NCI, or Cancer-cooperative group Phase I, II or Phase III Clinical Trials.

F-18 Fluorodeoxyglucose (FDG) Positron Emission Tomography
Often referred to as FDG-PET, when used in the diagnosis, staging, and subsequent management of malignant solid tumors and myelomas, including cervical cancer and prostate cancer.

Note: This service is covered under the Base Medical Program when used in the staging and management of many malignancies. Inclusion in the CarePlus program removes any restrictions on use of FDG-PET for the diagnosis, staging and management of any malignancy, including malignant bone marrow diseases.

Gene Transfer Therapy

  • Breast Cancer
  • Glioma
  • Leukemias
  • Lymphoma
  • Multiple Myeloma
  • Oropharyngeal Cancers
  • Chronic Lymphocytic Leukemia
  • For indications approved by: FDA, NIH/NHLBI, NCI Phase I, II or Phase III Clinical Trials

Hyperthermic Instillation Chemoperfusion
For treatment of cancer, including:

  • Bladder
  • Colon, Rectum, Anus
  • Peritoneum

Implantable Beta-Emitting Microspheres
For treatment of malignant liver tumors that are secondary to other cancers.

In Vitro Chemosensitivity Testing
For management, staging and treatment selection.

Intraoperative Radiation Therapy and Stereotactic Body Radiation Therapy

    • For multiple cancer types:
  • Brain and Spinal Tumors
  • Renal Cell Carcinoma
  • Colorectal Cancer
  • Adrenal Metastases
  • Lymph Node Metastases
  • Non-small-cell Lung Cancer
  • Pancreatic Cancer

Liquid Biopsy
A new screening tool to detect cellular debris or onco DNA from routine blood samples to stage and manage cancer.

Note: This service is covered under the Base Medical Program when used as an adjunct to whole Breast Irradiation.

Local or Focal Hyperthermia (Covered only for participants who do not have coverage for this service under their Base Medical Program)
As an adjunct to chemotherapy for treatment of:

  • Cutaneous, Subcutaneous, Non-invasive or Superficial Cancer of the Bladder
  • Cervical Cancer
  • Cancer of the Rectum or Anus

MRI/Ultrasound Image Fusion
For image-guided prostate biopsy.

Multiparametric MRI
An MRI technique to visualize the prostate gland in order to aid in prostate cancer detection.

Note: Only for members who do not have coverage under their Base Medical Program.

NanoKnife Electroporation
For hepatocellular carcinoma and pancreatic cancer.

Nplate® (Romiplostim) Thrombopoietin Stimulating Agent
For the treatment of thrombocytopenia due to chemotherapy or radiation therapy.

Pathwork® Tissue of Origin Test or Response DX™
Used to determine the type of cancer cells in tumors of unknown origin.

Photodynamic Therapy (PDT)

  • Bladder Cancer
  • Cutaneous Malignant Metastases (e.g., Breast Cancer)
  • Tumors of Tracheobronchial Tree
  • Nonmalignant Neoplasms of the Breasts (Fibroadenomas)

Radiofrequency Ablation (RF)

  • Lung Cancer
  • Metastatic Bone Cancer (palliation)
  • Prostate Cancer

Reflectance Confocal Microscopy
To detect and evaluate suspicious moles and dermal lesions.

Reolysin (Pelareorep)
As an adjunct to chemotherapy or radiation therapy for numerous cancers including, but not limited to:

  • Head and Neck
  • Ovarian
  • Soft Tissue Sarcoma

Tandem (Autologous followed by Autologous or Allogeneic) Stem Cell
Including stem cells derived from bone marrow, peripheral blood, umbilical cord blood, ex vivo expanded cord blood or more than one umbilical cord blood, i.e., “double cord.”

  • Multiple Myeloma
  • Lymphomas (Hodgkin’s and non-Hodgkin’s)
  • Acute Leukemias

Thermal (Laser) Coagulation
For treatment of benign breast tumors.

ThermoDox®
For treatment of primary and secondary liver cancer.

Transarterial Chemoembolization (TACE)
For treatment of malignant liver tumors that are secondary to other cancers.

Note: This service is covered under the Base Medical Program when used to treat primary liver cancer or metastases to the liver that are secondary to colorectal cancer.

CONTACT

AT&T Participants, Physicians and Other Health Care Providers:
1-877-261- 3340

The Summary Program Description (SPD) provided to you by AT&T is the legal document that describes the AT&T CarePlus Program. If there are any discrepancies between the information provided on this site and the SPD, the provision in the SPD will prevail.

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