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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that INITIAL COVERAGE FOR NEWLY DIAGNOSED GLIOBLASTOMA MULTIFORME: 
 
Tumor treatment field therapy (E0766) is covered for the treatment of newly diagnosed Glioblastoma 
Multiforme (GBM) only when all of the following criteria are met: 
 
   1. The beneficiary has histologically confirmed (World Health Organization (WHO) grade IV astrocytoma), 
newly diagnosed, supratentorial GBM; and, 
   2. The beneficiary has received initial treatment with maximal debulking surgery (when feasible), followed 
by chemotherapy and radiotherapy; and, 
   3. Tumor treatment field therapy is initiated within 7 weeks from the last dose of concomitant chemotherapy 
or radiotherapy, whichever is later; and, 
   4. The beneficiary has no evidence of progression by Response Assessment in Neuro-Oncology (RANO) 
criteria; and, 
   5. The beneficiary has a Karnofsky Performance Score (KPS) of at least 70; and, 
   6. The beneficiary will use TTFT for an average of 18 hours per day. 
 
If all of the coverage criteria above are not met, claims for code E0766 will be denied as not reasonable and 
necessary. 
 
CONTINUED COVERAGE FOR NEWLY DIAGNOSED GBM BEYOND THE FIRST THREE MONTHS 
OF THERAPY: 
 
Continued coverage of TTFT (E0766) beyond the first three months of therapy requires that no sooner than the 
60th day but no later than the 91st day after initiating therapy, the treating practitioner must conduct a clinical 
re-evaluation and document that the beneficiary is continuing to use and is benefiting from TTFT. 
 
Documentation of clinical benefit is demonstrated by: 
 
   1. In-person clinical re-evaluation by the treating practitioner; and,    2. Objective evidence of adherence to therapy, reviewed by the treating practitioner. 
 
Adherence to therapy is defined as the use of TTFT for an average of 18 hours per day (excluding days the 
treating practitioner has documented a medical need to limit or interrupt treatment). 
 
If the above criteria are not met, continued coverage of TTFT will be denied as not reasonable and necessary. 
 
If the practitioner re-evaluation does not occur until after the 91st day but the evaluation demonstrates that the 
beneficiary is benefiting from TTFT as defined in criteria 1 and 2 above, continued coverage of TTFT will 
commence with the date of that re-evaluation. See Policy Specific Documentation Requirements in the LCD-
related Policy Article, located in the Related Local Coverage Documents section of this LCD, for information 
about KX modifier use. 
 
RECURRENT GBM 
Tumor treatment field therapy (E0766) will be denied as not reasonable and necessary for the treatment of 
recurrent GBM. 
 
OTHER USES 
The use of TTFT for any indications other than newly diagnosed GBM will be denied as not reasonable and 
necessary. You can find this information in the Local Coverage Determination (LCD) for Tumor Treatment 
Field Therapy (TTFT) (L34823). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.