Umbilical Cord Blood Transplantation - Medicare Advantage

This policy addresses coverage of umbilical cord blood transplantation and cord blood–derived cellular therapies (e.g., Omisirge/omidubicel and Regenecyte) for use in allogeneic hematopoietic progenitor cell transplantation to restore hematopoietic and immune function. It is intended primarily for patients with hematologic malignancies (including adult and pediatric hematologic/lymphoid cancers and certain pediatric nonmalignant disorders) and those without matched donors, with Omisirge specified for ages 12–65 after myeloablative conditioning; major limitations include no CMS NCD/LCD, exclusions for age >65, pregnancy/breastfeeding or desire to conceive, renal failure, and requirement that referenced clinical criteria and approved treatment settings be met.

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