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

This article supplements NCD 110.23 and LCD L39477 to locally cover allogeneic hematopoietic cell transplantation for primary refractory or relapsed Hodgkin lymphoma and for B-cell or T-cell origin Non-Hodgkin lymphoma when NCD/LCD criteria are met. It requires a documented pretransplant evaluation (history/physical, labs, chest x‑ray, ECG, cardiac study, PFTs, disease restaging, functional status, risk and comorbidity scores) and documented pretransplant counseling including informed consent, fertility discussion when relevant, and advance care planning; incomplete documentation may result in denial. Coverage determinations that depend on NCD/LCD specifics or additional clinically indicated testing require manual review.

"Allogeneic hematopoietic cell transplantation (HCT) is covered for beneficiaries with primary refractory Hodgkin lymphoma when coverage criteria of CMS NCD 110."