Hematopoietic Cell Transplantation for Breast Cancer

This policy addresses hematopoietic cell transplantation (autologous and allogeneic HCT, including cord blood and reduced‑intensity regimens) for patients with breast cancer and states that HCT is considered experimental, investigational, and not covered for the treatment of any stage of breast cancer. Major limitations/requirements include the need for appropriate donor–recipient HLA matching for allogeneic HCT (with cord blood as a potential exception), substantial toxicity from conditioning that limits use to medically fit patients, ongoing investigational status of RIC/allogeneic approaches for solid tumors, and final coverage determinations depend on member benefit contracts and local Medicare decisions.

"Autologous or allogeneic hematopoietic cell transplantation is considered experimental, investigational, and/or unproven for the treatment of any stage of breast cancer (not covered)."