Does S2150 require prior authorization?

No, S2150 does not require prior authorization (low confidence). No active coverage policies found for this code.

What is the Medicare reimbursement rate for S2150?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

Verity

`S2150` — Bone marrow or blood-derived stem cells (peripheral or umbilical), allogeneic or autologous, harvesting, transplantation, and related complications; including: pheresis and cell preparation/storage; marrow ablative therapy; drugs, supplies, hospitalization with outpatient follow-up; medical/surgical, diagnostic, emergency, and rehabilitative services; and the number of days of pre-and post-transplant care in the global definition

HCPCS/CPT

Prior Authorization

No Prior Auth Required

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

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

ChronOS / TCP with bone marrow studies: documentation of diagnosis (benign cystic bone lesion type: non-ossifying fibroma, enchondroma, fibrous dysplasia, aneurysmal bone cyst, juvenile bone cyst), operative records showing mixing of ChronOS granules with autologous bone marrow harvested during surgery, and radiographic follow-up using Neer classification for bone regeneration.

For antibiotic bead local therapy (calcium sulfate beads): operative notes documenting debridement and bead placement, systemic antibiotic regimen, culture results, and follow-up documentation of wound status (presence/character of wound discharge) and radiographic dissolution of beads (authors reported beads dissolved at average ~36 days).

For INFUSE lumbar fusion: documentation that 'The member meets medical necessity criteria for lumbar spinal fusion in CPB 0743 - Spinal Surgery: Laminectomy and Fusion' and that 'INFUSE Bone Graft is to be implanted via an anterior (ALIF) or lateral (OLIF, DLIF, XLIF or LLIF) approach.'

For INFUSE in tibial shaft fractures: documentation that the patient is skeletally mature; that the acute, open tibial shaft fracture has been stabilized with intramedullary nail fixation; that appropriate wound management was performed; and that INFUSE Bone Graft will be applied within 14 days after the initial fracture.

For allograft use in spinal fusion and osteochondral defects: documentation that clinical indication meets the selection criteria for spinal fusion per CPB 0743 (reference to CPB 0743 required) or documentation of osteochondral defect requiring bone void filler.

20 Active Policies

AMBETTER-CP.MP.101 — Donor Lymphocyte Infusion

AMBETTER-CP.MP.141 — Nonmyeloablative Allogeneic Stem Cell Transplants

AMBETTER-CP.MP.162 — Tandem Transplant

SUR703.043 — Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia

CIGNA-0287 — Cell-Based Therapy for Cardiac and Peripheral Arterial Disease - (0287)

AETNA-CPB-0190 — Stem Cells for Hematopoietic Cell Transplant

AETNA-CPB-0394 — Epilepsy Surgery

AETNA-CPB-0411 — Bone and Tendon Graft Substitutes and Adjuncts

AETNA-CPB-0495 — Hematopoietic Cell Transplantation for Hodgkin's Disease

AETNA-CPB-0497 — Hematopoietic Cell Transplantation for Multiple Myeloma

AETNA-CPB-0602 — Intradiscal Procedures

AETNA-CPB-0606 — Hematopoietic Cell Transplantation for Autoimmune Diseases and Miscellaneous Indications

AETNA-CPB-0614 — Huntington's Disease

AETNA-CPB-0617 — Hematopoietic Cell Transplantation for Testicular Cancer

AETNA-CPB-0635 — Hematopoietic Cell Transplantation for Ovarian Cancer

AETNA-CPB-0638 — Donor Lymphocyte Infusion

AETNA-CPB-0674 — Hematopoietic Cell Transplantation for Chronic Myelogenous Leukemia

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

AMBETTER-CP.MP.108 — Allogeneic Hematopoietic Cell Transplants for Sickle Cell Anemia and β-Thalassemia

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

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