Diagnosis Codes
Covered Diagnosis Codes for Procedure Codes: 38206, 38220, 38221, 38232, 38241, S2150*
C71.0 |
C71.1 |
C71.2 |
C71.3 |
C71.4 |
C71.5 |
C71.6 |
C71.7 |
C71.8 |
Non-Covered Diagnosis Codes for Procedure Codes: 38205, 38230, 38240, S2140, S2142, S2150*
C71.0 |
C71.1 |
C71.2 |
C71.3 |
C71.4 |
C71.5 |
C71.6 |
C71.7 |
C71.8 |
Non-Covered Diagnosis Codes for Procedure Codes: 38205, 38206, 38220, 38221, 38230, 38232, 38240, 38241, S2140, S2142
C71.9
* The diagnosis procedure code S2150 may be considered medically necessary ONLY for autologous hematopoietic stem cell transplantation meeting policy criteria.