![]() ![]() ![]() Hematopoietic progenitor cell (HPC) allogeneic transplantation per donor Management of recipient hematopoietic progenitor cell donor search and cell acquisitionīlood-derived hematopoietic progenitor cell harvesting for transplantation, per collection allogeneicīlood-derived hematopoietic progenitor cell harvesting for transplantation, per collection autologousīone marrow or stem cell services/proceduresīone marrow harvesting for transplantation allogeneic or autologous Codes requiring a 7th character are represented by "+":ĬPT codes not covered for indications listed in the CPB:Īdministration (intra-arterial, intra-thecal, and intravenous) of autologous mesenchymal stem cells - no specific code Information in the below has been added for clarification purposes. Table: CPT Codes / HCPCS Codes / ICD-10 Codes Code Poor lung function (left ventricular ejection fraction (LVEF) of less than 50%).Severe lung disease (diffusing capacity of the lung for carbon monoxide (DLCO) of less than 40 % of the predicted value or forced vital capacity (FVC) of less than 45 % of the predicted value). ![]() Poor renal function (creatinine clearance of less than 40 ml/min).The member meets the transplanting institutions' selection criteria, or in the absence of such criteria, the member does not have any of the following exclusion criteria: Previous scleroderma-related renal disease and.Active interstitial lung disease (as determined by broncho-alveolar cell composition or ground-glass opacities on computed tomography of the chest) plus either a forced vital capacity (FVC) or a diffusing capacity of the lung for carbon monoxide (DLCO) of less than 70 % of the predicted value or.Recessive dystrophic epidermolysis bullosaĪetna considers the use of mesenchymal stem cell transplantation experimental and investigational for the treatment of autoimmune diseases (including ankylosing spondylitis and Sjogren’s syndrome) and selected indications listed in policy statement II.Īetna considers administration (intra-arterial, intra-thecal, and intravenous) of autologous mesenchymal stem cells experimental and investigational for the treatment of multiple system atrophy because its effectiveness has not been established.Īetna considers autologous umbilical cord blood stem cells experimental and investigational for the treatment of autism because the effectiveness of this approach has not been established.Īetna considers pluripotent stem cell-based retinal organoids experimental and investigational for restoration of blindness because the effectiveness of this approach has not been established.Īetna considers autologous hematopoietic cell transplantation medically necessary for the treatment of adults (18 to 69 years of age) with rapidly progressive scleroderma (systemic sclerosis) at risk of organ failure when either of the following is met:.Chronic inflammatory demyelinating polyradiculopathyĪetna considers hematopoietic cell transplantation (autologous or allogeneic) experimental and investigational for any of the following miscellaneous conditions (not an all-inclusive list) because its effectiveness for these indications has not been established:.Autoimmune cytopenia (e.g., autoimmune hemolytic anemia, Evans syndrome, and idiopathic thrombocytopenic purpura).Number: 0606 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background ReferencesĪetna considers hematopoietic cell transplantation (autologous or allogeneic) experimental and investigational for any of the following autoimmune diseases (not an all-inclusive list) because its effectiveness for these indications has not been established: ![]()
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