NCDActive
Autologous Cellular Immunotherapy Treatment
NCD344
Effective: June 30, 2011
Updated: December 31, 2025
Policy Summary
Sipuleucel-T (PROVENGE®) is nationally covered for Medicare beneficiaries with asymptomatic or minimally symptomatic metastatic castrate-resistant (hormone-refractory) prostate cancer for on‑label use effective 06/30/2011. Coverage is limited to the FDA‑approved indication; off‑label uses are not nationally covered and are left to local Medicare Administrative Contractor discretion. The FDA-approved regimen is three autologous doses given about two weeks apart (total ~4 weeks), with each dose containing at least 40 million treated white blood cells.
Coverage Criteria Preview
Key requirements from the full policy
"Sipuleucel-T (PROVENGE®) is nationally covered for Medicare beneficiaries with asymptomatic or minimally symptomatic metastatic castrate-resistant (hormone-refractory) prostate cancer."
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