M0075 — Cellular therapy
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- No explicit documentation requirements (e.g., pathology, prior treatments, diagnostic testing, or specific clinical notes) are listed in this background text.
- No explicit documentation requirements are stated in this excerpt of the CPB.
- The CPB provides lists of ICD-10 and HCPCS/CPT codes that are not covered for the indications listed; claim adjudication and medical record review should reference those coding lists to determine noncoverage.
- When relying on other CPBs (e.g., Acupuncture CPB 0135, Biofeedback CPB 0132, Chelation CPB 0234, Chiropractic CPB 0107, Electrical Stimulation CPB 0011), include documentation required per those CPBs (clinical notes, prior therapy trial details, objective findings) as applicable.
Key Coverage Criteria
- No covered indications are explicitly listed in this CPB. The bulletin primarily designates adoptive immunotherapy and cellular therapy approaches described below as experimental and investigational (i.e., not supported as effective).
- Note / exception: "This policy does not apply to lifileucel for the treatment of advanced melanoma." (lifileucel is handled separately).
- For CAR T therapies and specific agent coverage consult the related CPBs referenced (e.g., CPB 0920 Kymriah, CPB 0924 Yescarta, CPB 0980 Tecartus, CPB 0986 Breyanzi, CPB 0992 Abecma, CPB 1007 Carvykti).
- Metastatic melanoma (use of TIL, T-cell-based ACT, IL-2/LAK combinations discussed)
- Renal cell carcinoma (IL-2 with or without LAK/TIL studied)
- Lung cancer (including primary lung cancer; adjuvant chemo-immunotherapy using dendritic cells and activated killer cells; NSCLC)
2 Active Policies
AETNA-CPB-0388 — Complementary and Alternative Medicine
AETNA-CPB-0641 — Adoptive Immunotherapy and Cellular Therapy
Related Codes
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