Hematopoietic Stem Cell Transplantation - Medicare Advantage

This Humana Medicare Advantage policy adopts CMS NCD 110.23 and applicable MAC LCDs for coverage of hematopoietic stem cell transplantation. Covered indications include multiple malignant and marrow failure conditions (eg, aplastic anemia, leukemia, MDS, SCID, Wiskott-Aldrich, Hodgkin's disease, multiple myeloma, neuroblastoma, non-Hodgkin's lymphoma, primary AL amyloidosis) and allogeneic transplantation for primary refractory/relapsed Hodgkin/NHL per LCDs; autologous harvest/storage is conditionally covered for multiple myeloma when a future transplant is highly likely. Explicit exclusions include Crohn's disease, multiple sclerosis, systemic sclerosis, and stem cell harvest/hold solely to possibly treat post–CAR-T cytopenias (CPT 38225/38226), and all services must meet applicable MAC LCD/NCD documentation and medical necessity requirements.

"Multiple myeloma (stem cell transplantation referenced under CMS NCD 110."