Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin
L39396
Allogeneic hematopoietic cell transplantation from a healthy matched donor is covered for Medicare beneficiaries with primary refractory or relapsed Hodgkin and non-Hodgkin lymphomas of B- or T-cell origin when disease is refractory to standard-of-care or relapsed with no alternative curative options. Additional indications are covered per NCD 110.23 (eg, certain leukemias, aplastic anemia, SCID, Wiskott-Aldrich); several diagnoses (myelodysplastic syndrome, selected multiple myeloma stages, DIPSS-plus intermediate-2/high myelofibrosis, and severe symptomatic sickle cell disease) require participation in an approved prospective clinical study under the Coverage with Evidence Development (CED) paradigm. Documentation must include all NCD 110.23 mandated elements plus an in-depth history/physical, prior treatments and responses, rationale for transplant, informed patient/family education, and recommended risk and psychosocial assessments.
"Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) using healthy donor matched peripheral blood and/or bone marrow is covered for Medicare beneficiaries with primary refractory Hodgkin ..."