Hematopoietic Cell Transplantation for Aplastic Anemia and other Bone Marrow Failure Syndromes

Allogeneic hematopoietic cell transplantation (HCT) is covered for severe aplastic anemia, pure red cell aplasia, Diamond-Blackfan anemia refractory to corticosteroids, Fanconi anemia with severe marrow failure/MDS/AML, and for PNH with ongoing transfusion needs and a suitable HLA‑matched donor; autologous HCT (CPT 38232, 38241) is experimental/investigational and not covered for these indications. Coverage is contingent on meeting the transplanting institution’s selection criteria or, if those are unavailable, the policy’s specific clinical criteria (e.g., ≥3 of 4 marrow/cell count criteria for severe AA; marrow cellularity <25% plus reticulocyte <1% for PRCA; documented corticosteroid failure for DBA, etc.).

"Allogeneic hematopoietic cell transplantation (HCT) is medically necessary for the treatment of severe aplastic anemia when members meet the transplanting institution's selection criteria."