S1658
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- Autologous hematopoietic stem cell transplantation(AutoHSCT)for treatment of individuals with multiple myeloma is consideredmedically necessarywhen used as:
- As a single transplant (AutoHSCT);or
- As a tandem* transplant (two AutoHSCTs separated by 30 to 180 days);or
- As a repeat procedure (AutoHSCT greater than 180 days following a previous AutoHSCT);or
- As a pretreatment for a non-myeloablative allogeneic hematopoietic stem cell transplant;or
- As salvage therapy after:Primary graft failure;orFailure to engraft;orRejection following an allogeneic HSCT.
2 Active Policies
ANTHEM-MP-A045963 — Status
ANTHEM-MED.00147 — MED.00147 Cellular Therapy Products for Allogeneic Stem Cell Transplantation
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.