Does 38212 require prior authorization?

No, 38212 does not require prior authorization (low confidence). No active coverage policies found for this code.

What is the Medicare reimbursement rate for 38212?

Medicare facility rate: $40.42. Non-facility rate: $40.42. Work RVU: 0.92.

HCPCS/CPT

No Prior Auth Required

No active coverage policies found for this code (low confidence)

Work RVU

0.92

Facility

$40.42

Non-Facility

$40.42

Pre-transplant laboratory: serum bilirubin result.
Pre-transplant hemostasis: INR result with notation if patient is on oral anticoagulant therapy.
Cardiac assessment: MUGA scan or echocardiogram report documenting ejection fraction.
Pulmonary function testing: PFT results including FEV1 percent predicted and DLCO percent predicted.

Chronic granulomatous disease
Allogeneic (ablative and non-myeloablative) hematopoietic stem cell transplantationis consideredmedically necessaryfor individuals with the following disorders. In addition, individuals with Sickle Cell Disease or Thalassemia should meet the Disease Specific Criteria below.
Bone Marrow Failure SyndromesAcquired aplastic anemia (drug, idiopathic, immune disorder, toxin or viral infection)Heritable bone marrow syndromes:Congenital amegakaryocytic thrombocytopenia (CAMT)Diamond-Blackfan anemia (DBA)Dyskeratosis congenitaFanconiâs anemia (FA)Schwachman-Diamond syndrome (SDS)Paroxysmal nocturnal hemoglobinuria (PNH)
Acquired aplastic anemia (drug, idiopathic, immune disorder, toxin or viral infection)
Heritable bone marrow syndromes:Congenital amegakaryocytic thrombocytopenia (CAMT)Diamond-Blackfan anemia (DBA)Dyskeratosis congenitaFanconiâs anemia (FA)Schwachman-Diamond syndrome (SDS)
Congenital amegakaryocytic thrombocytopenia (CAMT)

ANTHEM-MP-A047560 — TRANS.00029 Hematopoietic Stem Cell Transplantation for Genetic Diseases and Aplastic Anemias

ANTHEM-MP-A070096 — TRANS.00034 Hematopoietic Stem Cell Transplantation for Diabetes Mellitus

ANTHEM-MP-A053844 — TRANS.00031 Hematopoietic Stem Cell Transplantation for Autoimmune Disease and Miscellaneous Solid Tumors

ANTHEM-MP-A053842 — TRANS.00030 Hematopoietic Stem Cell Transplantation for Germ Cell Tumors

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