Program Operations Manual System (POMS)
TN 70 (01-24)
COMPASSIONATE ALLOWANCES INFORMATION
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CHILD MEDULLOBLASTOMA
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ALTERNATE NAMES
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Embryonal Neuroepithelial Tumor; Anaplastic Medulloblastoma; Classic Medulloblastoma;
Desmoplastic Medulloblastoma; Large-cell Mesdulloblastoma; MBEN; Medulloblastoma with
Extensive Nodularity; Nodular Medulloblastoma; Primitive Neuroectodermal Tumor of
the Poterior Fossa
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DESCRIPTION
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Medulloblastoma is a rare primary central nervous system (CNS) tumor that starts in the cerebellum,
the part of the brain that controls muscle coordination, balance, and movement. Medulloblastomas
are cancerous and fast-growing. They often spread to other areas of the CNS through
cerebrospinal fluid (CSF). Rarely, medulloblastomas can spread outside the CNS to
the bones or the lymphatic system.
Medulloblastoma is primarily a childhood disease that mostly affects children and
teens under the age of 16. Though rarer in older individuals, it can occur in adults
as well. Medulloblastoma in adults is usually diagnosed between the ages of 20 and
44.
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM/ICD-10-CM CODING
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Diagnostic testing: The diagnosis of a medulloblastoma is made by:
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Neurological examination;
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Magnetic resonance imaging (MRI);
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Computed tomography (CT) scan;
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Positron emission tomography (PET) scan;
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Lumbar puncture (spinal tap) may be performed to obtain CSF to search for cancer cells
or tumor markers.
Physical findings: Symptoms of medulloblastoma depend on the tumor’s size and location, the child’s age,
and stage of development. Symptoms may include:
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Headaches which are often worse in the morning and get better during the day;
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Feeling tired or having changes in activity level;
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Problems with motor skills, such as clumsiness or poor handwriting;
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Tilting the head to one side;
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Double vision (diplopia);
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Rapid, jerky eye movements (nystagmus);
If the tumor has spread to the spinal cord, symptoms may include:
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Inability to control bladder and bowel functions.
ICD-9: 191.6
ICD-10: C71.6
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PROGRESSION
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Survival rates are dependent upon the child’s age, features of the tumor, how much
the tumor has spread, and response to treatment. About 60-65% of children with high
risk medulloblastomas live for five years or more. With multimodal treatment and appropriate
risk stratification, the long-term survival rate improves to 70–80%. Children younger
than age 3 often have lower survival rates because options for safe and effective
treatment may be limited.
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TREATMENT
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Surgery alone does not cure this type of cancer. Chemotherapy and radiation are often
used in combination with surgery.
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SUGGESTED PROGRAMMATIC ASSESSMENT*
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Suggested MER for Evaluation:
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Clinical history and examination that describes the diagnostic features of the impairment;
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Pathology/biopsy report of the cancer; and
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If available, spinal tap results.
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Suggested Listings for Evaluation:
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DETERMINATION
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LISTING
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REMARKS
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Meets
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13.13 A 2
113.13 B
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Medulloblastoma meets the criteria in listings 13.13 A 2 or 113.13 B upon confirmed
diagnosis.
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Equals
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* Adjudicators may, at their discretion, use the Medical Evidence of Record or the
listings suggested to evaluate the claim. However, the decision to allow or deny the
claim rests with the adjudicator.
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