Billing and Coding: Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin
A59042
This article supports coverage of allogeneic hematopoietic cell transplantation for beneficiaries with primary refractory or relapsed Hodgkin lymphoma and for relapsed or primary refractory Non-Hodgkin lymphoma of B-cell or T-cell origin, consistent with CMS NCD 110.23 and LCD L39270. Coverage requires a documented pretransplant evaluation (detailed H&P, labs, chest X-ray, ECG, cardiac function study, PFTs, disease-specific restaging, and institutional protocol completion) and documented pretransplant counseling including fertility and advance-care discussions and individualized informed consent. Lack of required documentation or nonconformance with the applicable NCD/LCD may result in noncoverage.
"Allogeneic hematopoietic cell transplantation (HCT) is covered for beneficiaries with primary refractory Hodgkin lymphoma."
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