MED.00147 Cellular Therapy Products for Allogeneic Stem Cell Transplantation

This policy addresses ex-vivo expansion of umbilical cord blood stem cell products (for example, omidubicel) for use in allogeneic hematopoietic stem cell transplantation. It is medically necessary for individuals age 12 or older who are candidates for myeloablative allogeneic HSCT to treat a hematologic malignancy, meet applicable transplant criteria in related policies, and are eligible and planned for umbilical cord blood transplantation following myeloablative conditioning. It is investigational and not medically necessary when these criteria are not met and for all other indications.

"Use of ex-vivo expansion of cord blood stem cell products (for example, omidubicel) is consideredmedically necessaryfor individuals when the following criteria are met:"

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