Effective for dates of service on or after July 1, 2021, prior approval (PA) for solid organ and stem cell transplants will no longer be required for North Carolina Medicaid fee for service (NC Medicaid Direct) and NC Health Choice beneficiaries. The following policies are being updated to reflect this change:
- 11A-1, Hematopoietic Stem-Cell Transplantation for Acute Lymphoblastic Leukemia (ALL)
- 11A-2, Hematopoietic Stem-Cell Transplantation for Acute Myeloid Leukemia (AML)
- 11A-3, Hematopoietic Stem-Cell Transplantation for Chronic Myeloid Leukemia (CML)
- 11A-5, Allogeneic Hematopoietic Transplantation for Genetic Diseases and Acquired Anemias
- 11A-6, Hematopoietic Stem-Cell Transplantation in the Treatment of Germ Cell Tumors
- 11A-7, Hematopoietic Stem-Cell Transplantation for Hodgkin Lymphoma
- 11A-8, Hematopoietic Stem-Cell Transplantation for Multiple Myeloma, POEMS Syndrome and Primary Amyloidosis
- 11A-9, Allogeneic Stem-Cell Transplantation for Myelodysplastic Syndromes & Myeloproliferative Neoplasms
- 11A-10, Hematopoietic Stem-Cell Transplantation (HSCT) for Central Nervous System (CNS) Embryonal Tumors & Ependymoma
- 11A-11, Hematopoietic Stem-Cell Transplantation for Non-Hodgkin Lymphomas
- 11A-14, Placental and Umbilical Cord Blood as a Source of Stem Cells
- 11A-15, Hematopoietic Stem-Cell Transplantation for Solid Tumors of Childhood
- 11A-16, Hematopoietic Stem-Cell Transplantation for Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL)
- 11B-1, Lung or Lobar Lung Transplantation
- 11B-2, Heart (Cardiac) Transplantation
- 11B-3, Islet Cell Transplantation
- 11B-5, Liver Transplantation
- 11B-6, Heart-Lung Transplantation
- 11B-7, Pancreas Transplant
- 11B-8, Small Bowel, Small Bowel/Liver or Multivisceral Transplants
Providers shall continue to comply with North Carolina Medicaid and NC Health Choice clinical coverage policy criteria. The Solid Organ Transplant and Stem Cell Transplant policies listed above are available on the Physician Clinical Coverage Policies page of the NC Medicaid website.
Contact
NCTracks Call Center: 800-688-6696