CMS Pub. 100-04, ch. 32, § 90.2

Allogeneic Stem Cell Transplantation

• Effective for services performed on or after August 1, 1978:

For the treatment of leukemia or leukemia in remission, providers shall use appropriate ICD-10 diagnosis codes

noted in section 90 and HCPCS code 38240.

For the treatment of aplastic anemia, providers shall use appropriate ICD-10 diagnosis codes noted in section

90 and HCPCS code 38240.

• Effective for services performed on or after June 3, 1985:

For the treatment of severe combined immunodeficiency disease, providers shall use appropriate ICD-10

diagnosis codes noted in section 90 and HCPCS code 38240.

For the treatment of Wiskott-Aldrich syndrome, providers shall use appropriate ICD-10-CM code D82.0 and

HCPCS code 38240.

Autologous Stem Cell Transplantation .--Is covered under the following circumstances effective for services

performed on or after April 28, 1989:

For the treatment of patients with acute leukemia in remission who have a high probability of relapse and who

have no human leucocyte antigens (HLA) matched, providers shall use appropriate ICD-10 diagnosis codes

noted in section 90 for lymphoid; myeloid; monocytic; acute erythremia; erythroleukemia; unspecified cell

type and HCPCS code 38241.

For the treatment of resistant non-Hodgkin’s lymphomas for those patients presenting with poor prognostic

features following an initial response, providers shall use appropriate ICD-10 diagnosis codes noted in section

90 and HCPCS code 38241.

For the treatment of recurrent or refractory neuroblastoma, providers shall use ICD- 10-CM codes

Neoplasm by site, malignant, the appropriate HCPCS code and HCPCS code 38241.

For the treatment of advanced Hodgkin’s disease for patients who have failed conventional therapy and

have no HLA-matched donor, providers shall use appropriate ICD-10 diagnosis codes and HCPCS code

38241

Autologous Stem Cell Transplantation.--Is covered under the following circumstances effective for services

furnished on or after October 1, 2000:

For the treatment of multiple myeloma (only for beneficiaries who are less than age 78, have Durie-Salmon stage II or III newly diagnosed or responsive multiple myeloma, and have adequate cardiac,

renal, pulmonary and hepatic functioning), providers shall use appropriate ICD-10-CM code and

HCPCS code 38241.

For the treatment of recurrent or refractory neuroblastoma, providers shall use appropriate code (see ICD-10-

CM neoplasm by site, malignant) and HCPCS code 38241.

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 autologous

stem cell transplantation (HDM/AuSCT) is reasonable and necessary for Medicare beneficiaries of any

age group for the treatment of primary amyloid light chain (AL) amyloidosis, ICD-10- CM codes E85.4,

E85.81, E85.9, and E85.89 who meet the following criteria:

Amyloid deposition in 2 or fewer organs; and,

Cardiac left ventricular ejection fraction (EF) greater than 45%.