Hematopoietic Cell Transplantation for Autoimmune Diseases and Miscellaneous Indications

Aetna covers autologous hematopoietic cell transplantation for adults 18–69 with rapidly progressive systemic sclerosis (ICD‑10 M34.0–M34.9) at risk of organ failure when there is active interstitial lung disease with FVC or DLCO <70% predicted or prior scleroderma‑related renal disease, but considers HCT (autologous or allogeneic) experimental and not covered for a broad list of other autoimmune diseases (e.g., MS, SLE/lupus nephritis, Crohn’s/ulcerative colitis, pemphigus, type 1 diabetes, RA, etc.). Members must meet the transplanting institution’s selection criteria (or lack specified exclusion criteria) and are excluded if they have creatinine clearance <40 mL/min, DLCO <40% or FVC <45% predicted, pulmonary arterial hypertension, LVEF <50%, or other trial‑derived exclusions (e.g., >6 months prior cyclophosphamide).

"Documentation that the patient has rapidly progressive scleroderma (systemic sclerosis) (ICD-10: M34."