This will be Medicare's first movement towards transplant coverage for a liver malignancy. Kang said a technology assessment would be sought for other types of malignancies in an effort to further expand Medicare coverage. A technology assessment is a study conducted either internally by HCFA specialists or by an outside consulting firm.
Hepatocellular carcinoma is the predominant primary malignancy of the liver.
It accounts for more than 80 percent of liver tumors. The tumors are predominantly found in male patients with cirrhotic livers from other disease, such as hepatitis. Medicare has covered liver transplants for adults since 1990, beginning with limited coverage of only 7 diagnoses. Coverage was expanded significantly in 1996 and 1999 to include all types of end-stage liver disease except for malignancies. The review of existing policy that led to the decision memorandum issued today was initiated internally at HCFA under the agency's new national coverage process, which bases coverage decisions on the best available scientific evidence.