S2107 — Adoptive immunotherapy i.e. development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment
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.
- Imaging and laboratory/biomarker data used in studies: brain CT or MRI, amyloid PET (e.g., florbetapir), cerebrospinal fluid (CSF) biomarkers (Aβ1-42, total tau, phospho-tau), and APOE ε4 genotyping when reported in trials.
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-0641 — Adoptive Immunotherapy and Cellular Therapy
AETNA-CPB-0788 — Alzheimer's Disease: Experimental Treatments
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.