Criteria
Allogeneic HCT may be considered medically necessary to treat individuals with markers of poor-risk disease for EITHER of the following conditions:
Use of a myeloablative or reduced-intensity pre-transplant conditioning regimen should be individualized based on factors that include individual age, the presence of comorbidities, and disease burden.
Allogeneic HCT to treat CLL or SLL not meeting the criteria as indicated in this policy is considered experimental/investigational and therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.
Autologous HCT to treat CLL or SLL not meeting the criteria as indicated in this policy is considered experimental/investigational, and therefore, non-covered, because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.
Procedure Codes
38205 | 38206 | 38240 | 38241 | S2140 | S2142 |
