ND Committee Review
Internal Medical Policy Committee 11-14-2019 Adopt policy
Internal Medical Policy Committee 11-19-2020 Remove NCCN recommendation "mobilization of donor hematopoietic progenitor cells in the allogeneic setting" as this is a 2B recommendation
Internal Medical Policy Committee 5-20-2021 Changed Myeloid to Hematopoietic in the policy and added statement "Mobilization of donor hematopoietic progenitor cells in the allogeneic setting." back to policy
Internal Medical Policy Committee 9-21-2021 Added diagnosis code C56.3 to the policy
Internal Medical Policy Committee 7-21-2022 Removed diagnosis codes C56.1, C56.2, C56.3, C56.9, C62.00, C62.01, C62.02, C62.10, C62.11, C62.12, C62.9, C62.91 and C62.92, removed NCCN recommendations and added this statement "Plerixafor (Mozobil) may be considered medically necessary for treatment of any of the current category 1 or 2A NCCN recommendations." and updated experimental/investigational statement
