64910
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
10.26
Facility
$697.08
Non-Facility
$697.08
Documentation Required
- No explicit documentation requirements (medical records, test results, prior authorization criteria) are specified in the provided document text.
- No explicit documentation requirements, billing criteria, ICD-10 or CPT codes, or specific record-keeping instructions are provided in this document.
- The document repeatedly calls for clinical-trial–quality documentation (well-defined end-points, power calculations, appropriate statistical methods) for future studies but does not specify documentation required for coverage.
- Pathology and oncologic records as applicable (e.g., cancer diagnosis, BRCA status, mastectomy specimen details) when reconstruction is performed for oncologic indications.
Key Coverage Criteria
- No explicit covered indications are stated in this document. The text describes investigational/experimental uses of stem cell and cell-based therapies in multiple clinical scenarios, including:
- Ischemic heart disease / acute myocardial infarction (AMI) — investigations of intracoronary or intramyocardial delivery of bone marrow mononuclear cells (BMCs/BM-MNC), mesenchymal stem cells (MSCs), cardiosphere-derived cells (CDCs), autologous skeletal myoblasts (ASM), and allogeneic MSCs.
- Chronic ischemic heart disease / heart failure (including ischemic cardiomyopathy, advanced heart failure, reduced LVEF) — trials of transendocardial, intracoronary, and intramyocardial delivery of various cell types (BMC, MSC, cardiopoietic cells, CDCs, skeletal myoblasts).
- Peripheral arterial disease (PAD) and critical limb ischemia (CLI) — intra-arterial or intramuscular implantation/infusion of autologous bone marrow mononuclear cells (BMMNCs / mBMCs) or peripheral blood mononuclear cells.
- Dilated cardiomyopathy (DCM) — intracoronary infusion of BMMCs or BMSCs evaluated in small randomized studies.
- Pediatric cardiomyopathy — small pilot intracoronary stem cell trials in children.
8 Active Policies
AETNA-CPB-0185 — Breast Reconstructive Surgery
SUR710.019 — Nerve Graft with Radical Prostatectomy
AETNA-CPB-0599 — Autologous Skeletal Myoblast/Mononuclear Bone Marrow Cell Transplantation
BCBSIL-SUR710.019 — Nerve Graft with Radical Prostatectomy
BCBSMT-SUR710.019 — Nerve Graft with Radical Prostatectomy
Related Codes
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