![]() ![]() Management of recipient hematopoietic progenitor cell donor search and cell acquisitionīlood-derived hematopoietic progenitor cell harvesting for transplantation, per collection allogenic Codes requiring a 7th character are represented by "+":ĬPT codes covered if selection criteria are met: Information in the below has been added for clarification purposes. Table: CPT Codes / HCPCS Codes / ICD-10 Codes Code Note: Relapse is the re-appearance of disease in regions of prior disease (recurrence) and/or in new regions (extension) after initial therapy and attainment of complete response. Tandem (also known as sequential) transplants are considered experimental and investigational for the treatment of HD because there is insufficient of its effectiveness and safety for this approach. Note: Aetna considers non-myeloablative allogeneic hematopoietic cell transplantation ("mini-transplant," reduced intensity conditioning transplant) medically necessary for the treatment of members with relapsed HD (including members who have relapsed or have had persistent disease after an autologous hematopoietic cell transplant) or primary refractory HD when they are eligible for conventional allografting. In the absence of such criteria, for the treatment of members with relapsed or primary refractory HD when both of the following selection criteria are met:.For the treatment of members with relapsed HD (including members who have relapsed or have had persistent disease from an autologous hematopoietic cell transplant) or primary refractory HD when the member meets the transplanting institution's selection criteria.Allogeneic Hematopoietic Cell Transplantation.The member is without serious organ dysfunction based on the transplanting institution's evaluation.The member is in primary induction failure or beyond first remission and.In the absence of such criteria, for the treatment of HD when both of the following selection criteria are met:.For the treatment of Hodgkin's disease (HD) when the member meets the transplanting institution's selection criteria.Autologous Hematopoietic Cell Transplantation.This Clinical Policy Bulletin addresses hematopoietic cell transplantation for Hodgkin's Disease.Īetna considers the following interventions medically necessary: Number: 0495 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References
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