Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin
L39398
Allogeneic hematopoietic stem cell transplantation using matched donor peripheral blood or bone marrow is covered for Medicare beneficiaries with primary refractory or relapsed Hodgkin lymphoma or B- or T-cell non-Hodgkin lymphoma when disease is refractory to standard-of-care or relapsed with no alternative potentially curative options. Additional diagnoses are covered per NCD 110.23, with certain conditions (e.g., specific stages of multiple myeloma, myelodysplastic syndrome, high-risk myelofibrosis, and severe sickle cell disease) covered only under Coverage with Evidence Development (CED) in approved prospective clinical studies; documentation meeting NCD 110.23 requirements must be retained and made available to Medicare. All procedural steps (mobilization, harvesting, transplant) are included in coverage when the transplant is covered, and when transplant is non-covered none of those steps are reimbursed; all other indications not specified remain at MAC discretion.