National_Coverage_Determinations_Manual / STEM_CELL_TRANSPLANTATION

Why This Topic Matters

Coverage policy for stem cell transplantation affects claim adjudication, medical necessity review, and documentation expectations. Understanding the national coverage framework and its dated revisions helps users determine whether a transplant scenario is addressed by national policy or left to local discretion.

Article Sections

1. A. General

   Introduces stem cell transplantation and distinguishes broad transplant categories used in the policy.

2. 1. Allogeneic Stem Cell Transplantation

   Provides the national coverage framework for the donor-derived transplant category, including covered and noncovered uses over time.

3. a. Covered Indications

   Summarizes the situations identified as covered under Medicare for the allogeneic transplant category.

4. b. Noncovered Indications

   Summarizes the situations identified as not covered under Medicare for the allogeneic transplant category.

5. 2. Autologous Stem Cell Transplantation (AuSCT)

   Provides the national coverage framework for the patient-derived transplant category, including dated policy revisions.

6. a. Covered Indications

   Summarizes the situations identified as covered under Medicare for the autologous transplant category.

7. b. Noncovered Indications

   Summarizes the situations identified as not covered under Medicare for the autologous transplant category.

8. B. Other

   Addresses transplant scenarios not specifically classified as nationally covered or noncovered and their general policy status.