Author: GDIT, (800) 688-6696
The following Hematopoietic Stem Cell Transplantation (HSCT) clinical coverage policies have been revised. The revisions, which will become effective Oct. 1, 2019 are outlined below:
11A-1 Hematopoietic Stem Cell Transplantation for Acute Lymphoblastic Leukemia (ALL)
- Coverage added for allogeneic HSCT to treat relapsing ALL after a prior autologous HSCT for both children and adults.
- Coverage criteria added and prior approval requirement removed from the donor lymphocyte infusion (DLI) procedure (CPT 38242).
11A-2 Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia (AML)
- AML description, classifications, and prognostic factors updated in accordance with the new 2016 World Health Organization (WHO) classifications.
- Coverage criteria added and prior approval requirement removed from the donor lymphocyte infusion (DLI) procedure (CPT 38242).
- Clarified coverage criteria to specify situations in which AML relapses or is refractory to induction chemotherapy but can be brought into remission with intensified induction chemotherapy.
11A-3 Hematopoietic Stem Cell Transplantation for Chronic Myeloid Leukemia (AML)
- Terminology changed from chronic myelogenous leukemia to chronic myeloid leukemia throughout policy.
- Coverage criteria added and prior approval requirement removed from the donor lymphocyte infusion (DLI) procedure (CPT 38242).
11A-5 Allogeneic Hematopoietic Stem Cell Transplantation for Genetic Diseases and Acquired Anemias
- Title of policy edited from “Allogeneic Hematopoietic Stem Cell & Bone Marrow Transplant for Genetic Diseases and Acquired Anemias” to above.
11A-6 Hematopoietic Stem Cell Transplantation in the Treatment of Germ Cell Tumors
- Definitions added for salvage therapy and tandem transplants.
11A-7 Hematopoietic Stem Cell Transplantation for Hodgkin Lymphoma
- Definitions added for induction therapy and tandem transplants.
- Coverage criteria added and prior approval requirement removed from the donor lymphocyte infusion (DLI) procedure (CPT 38242).
11A-8 Hematopoietic Stem Cell Transplantation for Multiple Myeloma, POEMS Syndrome, and Primary Amyloidosis
- POEMS syndrome added to policy title and coverage criteria. Autologous HSCT is indicated to treat disseminated POEMS syndrome.
- Definitions added for M protein, salvage therapy, and tandem transplants.
- Policy Guidelines revised to define levels of response to treatment for multiple myeloma.
11A-9 Hematopoietic Stem Cell Transplantation for Myelodysplastic Syndromes & Myeloproliferative Neoplasms
- Coverage criteria added and prior approval requirement removed from the donor lymphocyte infusion (DLI) procedure (CPT 38242).
- Policy Guidelines updated to reflect new 2016 WHO classifications.
11A-11 Hematopoietic Stem Cell Transplantation for Non-Hodgkin Lymphomas
- Updated to the new 2016 WHO classifications for lymphoid neoplasms.
- Coverage criteria added and prior approval requirement removed from the donor lymphocyte infusion (DLI) procedure (CPT 38242).
11A-14 Placental and Umbilical Cord Blood as a Source of Stem Cells
- Updated criteria to allow the use of cord blood in any case where allogeneic transplant would be indicated.
11A-16 Hematopoietic Stem Cell Transplantation for Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL)
- Provided highlights to changes in new 2016 WHO classification.
- Coverage criteria added and prior approval requirement removed from the donor lymphocyte infusion (DLI) procedure (CPT 38242).
- Revised text discussing adverse and favorable prognostic factors.