Medicare Intermediary Manual - Part 3 - Claims Process Transmittal 1805
Section 3614, Stem Cell Transplantation, provides claims processing instructions for the coverage of stem cell transplants. It has been updated to include both the covered and noncovered diagnosis and procedure codes for allogeneic and autologous stem cell transplants. In addition to clarifying the current coverage as described in the Coverage Issues Manual §35-30.1, effective 10/01/2000, autologous stem cell transplantation will also be covered for Medicare beneficiaries with multiple myeloma, less than age 78 who have Durie-Salmon stage II or III newly diagnosed or responsive multiple myeloma with adequate cardiac, renal, pulmonary, and hepatic function. Multiple rounds of autologous stem cell transplantation (known as tandem transplantation) will, however, remain non-covered. The Coverage Issues Manual also includes nonprimary amyloidosis as a noncovered condition and primary (AL) amyloidosis as a noncovered condition for Medicare beneficiaries age 64 or older.
Section 3614.1, Allogeneic Stem Cell Transplantation, provides background, coverage, and coding information on Allogeneic stem cell transplantation.
Section 3614.2, Autologous Stem Cell Transplantation, provides background, coverage, and coding information on Autologous stem cell transplantation.
Section 3614.3, Acquisition Costs, provides information on stem cell acquisition charges. Please notify your providers of these changes.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: August 29, 2000
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