CMS Pub. 100-04, ch. 3, § 90.3.2

A. - General

Autologous stem cell transplantation (AuSCT) is a technique for restoring stem cells

using the patient's own previously stored cells. AuSCT must be used to effect

hematopoietic reconstitution following severely myelotoxic doses of chemotherapy

(high dose chemotherapy (HDCT)) and/or radiotherapy used to treat various

malignancies.

If ICD-10-PCS is applicable, use the following Procedure Codes and Descriptions -

30230C0 Transfusion of Autologous Hematopoietic Stem/Progenitor Cells,

Genetically Modified into Peripheral Vein, Open Approach

30230G0 Transfusion of Autologous Bone Marrow into Peripheral Vein, Open

Approach

30230Y0 Transfusion of Autologous Hematopoietic Stem Cells into Peripheral

Vein, Open Approach

30233G0 Transfusion of Autologous Bone Marrow into Peripheral Vein,

Percutaneous Approach

30233C0 Transfusion of Autologous Hematopoietic Stem/Progenitor Cells,

Genetically Modified into Peripheral Vein, Percutaneous Approach

30233Y0 Transfusion of Autologous Hematopoietic Stem Cells into Peripheral

Vein, Percutaneous Approach

30240C0 Transfusion of Autologous Hematopoietic Stem/Progenitor Cells,

Genetically Modified into Central Vein, Open Approach

30240G0 Transfusion of Autologous Bone Marrow into Central Vein, Open

Approach

30240Y0 Transfusion of Autologous Hematopoietic Stem Cells into Central Vein,

Open Approach

30243C0 Transfusion of Autologous Hematopoietic Stem/Progenitor Cells,

Genetically Modified into Central Vein, Percutaneous Approach

30243G0 Transfusion of Autologous Bone Marrow into Central Vein,

Percutaneous Approach

30243Y0 Transfusion of Autologous Hematopoietic Stem Cells into Central Vein,

Percutaneous Approach

NOTE: Please note that effective September 30, 2021 PCS codes for Allogeneic SCT

30230G2, 30230G3, 30230Y2, 30230Y3, 30240G2, 30240G3, 30240Y2, 30240Y3 and PCS

codes for Autologous SCT 30230C0, 30230G0, 30230Y0, 30240C0, 30240G0, 30240Y0 are

end-dated.

B. - Covered Conditions

1. Effective for services performed on or after April 28, 1989:

For acute leukemia in remission for patients who have a high probability of relapse and

who have no human leucocyte antigens (HLA)-matched, the following diagnosis codes

are reported:

If ICD-10-CM is applicable, use the following Diagnosis Codes and Descriptions -

Diagnosis

Code

Description

C91.01 Acute lymphoblastic leukemia, in remission

C92.01 Acute myeloblastic leukemia, in remission

C92.41 Acute promyelocytic leukemia, in remission

C92.51 Acute myelomonocytic leukemia, in remission

C92.61 Acute myeloid leukemia with 11q23-abnormality in remission

C92.A1 Acute myeloid leukemia with multilineage dysplasia, in remission

C93.01 Acute monoblastic/monocytic leukemia, in remission

C94.01 Acute erythroid leukemia, in remission

C94.21 Acute megakaryoblastic leukemia, in remission

C95.01 Acute leukemia of unspecified cell type, in remission

For resistant non-Hodgkin's lymphomas or those presenting with poor prognostic

features following an initial response the following diagnosis codes are reported:

If ICD-10-CM is applicable use the following, code ranges C82.01 - C85.29, C85.81 -

C86.6, C96.4, and C96.Z - C96.9.

Recurrent or refractory neuroblastoma (see ICD-10-CM codes Neoplasm by

site, malignant for the appropriate diagnosis code)

following ranges are reported: C00 - C96, and D00 - D09 Resistant non-Hodgkin’s lymphomas); or,

Advanced Hodgkin's disease who have failed conventional therapy and have no

HLA-matched donor (ICD-10-CM codes C81.01 - C81.99).

2. Effective for services performed on or after October 1, 2000:

Durie-Salmon Stage II or III that fit the following requirement are covered: Newly

diagnosed or responsive multiple myeloma (if ICD-10-CM is applicable, diagnosis

codes C90.00, C90.01, C90.02, and D47.Z9). This includes those patients with

previously untreated disease, those with at least a partial response to prior

chemotherapy (defined as a 50% decrease either in measurable paraprotein [serum

and/or urine] or in bone marrow infiltration, sustained for at least 1 month), and those

in responsive relapse, and adequate cardiac, renal, pulmonary, and hepatic function.

3. Effective for Services On or After March 15, 2005

Effective for services performed on or after March 15, 2005, when recognized clinical

risk factors are employed to select patients for transplantation, high-dose melphalan

(HDM), together with AuSCT, in treating Medicare beneficiaries of any age group with

primary amyloid light-chain (AL) amyloidosis who meet the following criteria:

• Amyloid deposition in 2 or fewer organs ; and,

• Cardiac left ventricular ejection fraction (EF) of 45% or greater.

NOTE: Please note that effective April 01, 2022 unspecified ICD-10-DX codes C47.9,

C72.50, C72.9, C81.91, C81.92, C81.93, C81.94, C81.95, C81.96, C81.97, C81.98, C81.99,

C85.91, C85.92, C85.93, C85.94, C85.96, C85.97, C85.98, C85.99, C91.91, C92.91, C93.91,

C95.91, C96.20, C96.9 are end-dated.

C. – Non-covered Conditions

Insufficient data exist to establish definite conclusions regarding the efficacy of autologous

stem cell transplantation for the following conditions:

a) Acute leukemia not in remission prior to October 1, 2000 ( if ICD-10-CM is

applicable, ICD-10-CM codes C91.00, C92.00, C93.00, C94.00, and C95.00)

b) Chronic granulocytic leukemia prior to October 1, 2000 (if ICD-10-CM is applicable,

ICD-10-CM code C92.10);

c) Solid tumors prior to October 1, 2000 (other than neuroblastoma) (if ICD-10-CM is

applicable, ICD-10-CM codes C00.0 – C80.2 and D00.0 – D09.9);

d) Multiple myeloma prior to October 1, 2000 (if ICD-10-CM is applicable, ICD-10-

CM codes C90.00, C90.01, C90.02 and D47.Z9);

e) Tandem transplantation, on or after October 1, 2000 (if ICD-10-CM is applicable,

ICD-10-CM codes C90.00, C90.01, C90.02, and D47.Z9) ;

f) Non- primary amyloidosis on or after 10/01/00, for all Medicare beneficiaries

g) Primary AL amyloidosis effective October 1, 2000, through March 14, 2005 for

Medicare beneficiaries age 64. (if ICD-10-CM is applicable, ICD-10-CM codes E85.4,

E85.81, E85.9, and E85.89);

NOTE: Coverage for conditions other than these specifically designated as covered or

non- covered is left to the discretion of the A/B MAC (A).

D. Billing for Autologous Stem Cell Transplantation (AuSCT)

The hospital bills and shows all charges for autologous stem cell harvesting, processing,

and transplant procedures based on the status of the patient (i.e., inpatient or outpatient)

when the services are furnished. It shows charges for the actual transplant, in revenue

center code 0362 or another appropriate cost center. ICD-10-PCS codes are used to

identify inpatient procedures.

The HCPCS codes describing autologous stem cell harvesting procedures may be billed

and are separately payable under the OPPS when provided in the hospital outpatient

setting of care. Autologous harvesting procedures are distinct from the acquisition

services described in Pub. 100-04, chapter 4, §231.11 and section 90.3.1-A above for

allogeneic stem cell transplants, which include services provided when stem cells are

obtained from a donor and not from the patient undergoing the stem cell transplant. The

HCPCS codes describing autologous stem cell processing procedures also may be billed

and are separately payable under the OPPS when provided to hospital outpatients.

Payment for autologous stem cell harvesting procedures performed in the hospital

inpatient setting of care, with transplant also occurring in the inpatient setting of care, is

included in the MS-DRG payment for the autologous stem cell transplant.