CMS Pub. 100-04, ch. 32, § 90.3

Autologous stem cell transplantation is not covered 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 those specifically designated as covered in

90.2 or 90.2.1 or specifically designated as non-covered in this section will be at the discretion of the

individual A/B MAC (B).