US · guidance
CMS Pub. 100-04, ch. 32, § 400.5
Claims Editing
A. Fee-For-Service Medicare
Medicare edits CAR T-cell therapy claims based on requirements found in NCD 110.24.
B. Beneficiaries enrolled in Medicare Advantage (MA) plans
Effective for clams with dates of service on and after August 7, 2019, CMS determined that the NCD requiring coverage
of CAR T-cell therapy for cancer is a significant cost under section 422.109(a)(2) of title 42 of the Code of Federal
Regulations. As a result, for CYs 2019 (beginning August 7, 2019) and 2020 only, original fee-for-service Medicare will
pay for CAR T-cell therapy for cancer obtained by beneficiaries enrolled in Medicare Advantage (MA) plans when the
coverage criteria outlined in the NCD are met. Plans should account for CAR T-cell therapy for cancer items and
services in their contract year 2021 bids.
Consistent with §1862 (t)(2) of the Act, MACs will pay for CAR T-cell therapy for cancer for Medicare beneficiaries
enrolled in MA plans in CYs 2019 (beginning August 7, 2019) and 2020.
History
(Rev. 11721; Issued: 11-28-22; Effective: 01-01-23; Implementation: 01-03-23)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
593dec18fb1859a3f9cc95b2f2d4528f772a4237e0bcf1c5361cbbf369afcd2a
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.