Clinical Coverage Policies

  • 11B-1, Lung Transplantation
  • 11B-2, Heart Transplantation
  • 11B-3, Islet Cell Transplantation
  • 11B-4, Kidney (Renal) Transplantation
  • 11B-5, Liver Transplantation
  • 11B-6, Heart/Lung Transplantation
  • 11B-7, Pancreas Transplant
  • 11B-8, Small Bowel and Small Bowel/Liver and Multivisceral Transplants
  • 10A, Outpatient Specialized Therapies
  • 10B, Independent Practitioners (IP)
  • 10C, Local Education Agencies (LEAs)
  • 10D, Independent Practitioners Respiratory Therapy Services
  • 11A-1, Hematopoietic Stem-Cell Transplantation for Acute Lymphoblastic Leukemia (ALL)

  • 11A-2, Hematopoietic Stem-Cell Transplant for Acute Myeloid Leukemia)

  • 11A-3, Hematopoietic Stem-Cell Transplantation for Chronic Myelogenous Leukemia

  • 11A-5, Allogeneic Hematopoietic Transplant 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 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 Transplant for Non-Hodgkin’s Lymphoma

  • 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)

  • 11A-17, CAR-T Cell Therapy         

12B, Human Immunodeficiency Virus (HIV) Case Management

1-H, Telehealth, Virtual Communications and Remote Patient Monitoring

6A, Routine Eye Examination and Visual Aids for Beneficiaries Under 21 years of Age

6B, Routine Eye Examination and Visual Aids for Beneficiaries 21 Years of Age and Older