TRANS.00031 Hematopoietic Stem Cell Transplantation for Autoimmune Disease and Miscellaneous Solid Tumors

This policy addresses hematopoietic stem cell transplantation (HSCT), including ablative and non-myeloablative (mini-transplant) approaches, for multiple sclerosis (MS) and other autoimmune diseases/miscellaneous solid tumors. Coverage is limited to a single autologous HSCT for relapsing-remitting MS when all criteria are met: age 18–45, disease duration <10 years, EDSS 2.0–5.5 with ability to walk 100 meters unaided, and highly active, treatment‑resistant disease with recent relapses and/or new MRI lesions; all other uses—including when these criteria are not met (e.g., primary or secondary progressive MS), repeat autologous HSCT, allogeneic or planned tandem HSCT, and HSCT for other autoimmune diseases or miscellaneous solid tumors—are investigational and not medically necessary.

"Asingleautologous (ablative or non-myeloablative [mini-transplant]) hematopoietic stem cell transplantation is consideredmedically necessaryfor individuals withmultiple sclerosiswhenallof the follo..."