Autologous Stem Cell Transplantation (AuSCT)

90.3.2 - Autologous Stem Cell Transplantation (AuSCT) (Rev.11348; Issued: 04-07-22; Effective: 05-09-22; Implementation: 05-09-22) A. - General Autologous stem cell transplantation (AuSCT) is a technique for restoring stem cells using the patient's own previously stored cells. AuSCT must be used to effect hematopoietic reconstitution following severely myelotoxic doses of chemotherapy (high dose chemotherapy (HDCT)) and/or radiotherapy used to treat various malignancies. If ICD-10-PCS is applicable, use the following Procedure Codes and Descriptions - 30230C0 Transfusion of Autologous Hematopoietic Stem/Progenitor Cells, Genetically Modified into Peripheral Vein, Open Approach 30230G0 Transfusion of Autologous Bone Marrow into Peripheral Vein, Open Approach 30230Y0 Transfusion of Autologous Hematopoietic Stem Cells into Peripheral Vein, Open Approach 30233G0 Transfusion of Autologous Bone Marrow into Peripheral Vein, Percutaneous Approach 30233C0 Transfusion of Autologous Hematopoietic Stem/Progenitor Cells, Genetically Modified into Peripheral Vein, Percutaneous Approach 30233Y0 Transfusion of Autologous Hematopoietic Stem Cells into Peripheral Vein, Percutaneous Approach 30240C0 Transfusion of Autologous Hematopoietic Stem/Progenitor Cells, Genetically Modified into Central Vein, Open Approach 30240G0 Transfusion of Autologous Bone Marrow into Central Vein, Open Approach 30240Y0 Transfusion of Autologous Hematopoietic Stem Cells into Central Vein, Open Approach 30243C0 Transfusion of Autologous Hematopoietic Stem/Progenitor Cells, Genetically Modified into Central Vein, Percutaneous Approach 30243G0 Transfusion of Autologous Bone Marrow into Central Vein, Percutaneous Approach 30243Y0 Transfusion of Autologous Hematopoietic Stem Cells into Central Vein, Percutaneous Approach NOTE: Please note that effective September 30, 2021 PCS codes for Allogeneic SCT 30230G2, 30230G3, 30230Y2, 30230Y3, 30240G2, 30240G3, 30240Y2, 30240Y3 and PCS codes for Autologous SCT 30230C0, 30230G0, 30230Y0, 30240C0, 30240G0, 30240Y0 are end-dated. B. - Covered Conditions 1. Effective for services performed on or after April 28, 1989: For acute leukemia in remission for patients who have a high probability of relapse and who have no human leucocyte antigens (HLA)-matched, the following diagnosis codes are reported: If ICD-10-CM is applicable, use the following Diagnosis Codes and Descriptions - Diagnosis Code Description C91.01 Acute lymphoblastic leukemia, in remission C92.01 Acute myeloblastic leukemia, in remission C92.41 Acute promyelocytic leukemia, in remission C92.51 Acute myelomonocytic leukemia, in remission C92.61 Acute myeloid leukemia with 11q23-abnormality in remission C92.A1 Acute myeloid leukemia with multilineage dysplasia, in remission C93.01 Acute monoblastic/monocytic leukemia, in remission C94.01 Acute erythroid leukemia, in remission C94.21 Acute megakaryoblastic leukemia, in remission C95.01 Acute leukemia of unspecified cell type, in remission For resistant non-Hodgkin's lymphomas or those presenting with poor prognostic features following an initial response the following diagnosis codes are reported: If ICD-10-CM is applicable use the following, code ranges C82.01 - C85.29, C85.81 - C86.6, C96.4, and C96.Z - C96.9. Recurrent or refractory neuroblastoma (see ICD-10-CM codes Neoplasm by site, malignant for the appropriate diagnosis code) following ranges are reported: C00 - C96, and D00 - D09 Resistant non- Hodgkin’s lymphomas); or, Advanced Hodgkin's disease who have failed conventional therapy and have no HLA-matched donor (ICD-10-CM codes C81.01 - C81.99). 2. Effective for services performed on or after October 1, 2000: Durie-Salmon Stage II or III that fit the following requirement are covered: Newly diagnosed or responsive multiple myeloma (if ICD-10-CM is applicable, diagnosis codes C90.00, C90.01, C90.02, and D47.Z9). This includes those patients with previously untreated disease, those with at least a partial response to prior chemotherapy (defined as a 50% decrease either in measurable paraprotein [serum and/or urine] or in bone marrow infiltration, sustained for at least 1 month), and those in responsive relapse, and adequate cardiac, renal, pulmonary, and hepatic function. 3. Effective for Services On or After March 15, 2005 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 AuSCT, in treating Medicare beneficiaries of any age group with primary amyloid light-chain (AL) amyloidosis who meet the following criteria: • Amyloid deposition in 2 or fewer organs ; and, • Cardiac left ventricular ejection fraction (EF) of 45% or greater. NOTE: Please note that effective April 01, 2022 unspecified ICD-10-DX codes C47.9, C72.50, C72.9, C81.91, C81.92, C81.93, C81.94, C81.95, C81.96, C81.97, C81.98, C81.99, C85.91, C85.92, C85.93, C85.94, C85.96, C85.97, C85.98, C85.99, C91.91, C92.91, C93.91, C95.91, C96.20, C96.9 are end-dated. C. – Non-covered Conditions Insufficient data exist to establish definite conclusions regarding the efficacy of autologous stem cell transplantation 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 these specifically designated as covered or non- covered is left to the discretion of the A/B MAC (A). D. Billing for Autologous Stem Cell Transplantation (AuSCT) The hospital bills and shows all charges for autologous stem cell harvesting, processing, and transplant procedures based on the status of the patient (i.e., inpatient or outpatient) when the services are furnished. It shows charges for the actual transplant, in revenue center code 0362 or another appropriate cost center. ICD-10-PCS codes are used to identify inpatient procedures. The HCPCS codes describing autologous stem cell harvesting procedures may be billed and are separately payable under the OPPS when provided in the hospital outpatient setting of care. Autologous harvesting procedures are distinct from the acquisition services described in Pub. 100-04, chapter 4, §231.11 and section 90.3.1-A above for allogeneic stem cell transplants, which include services provided when stem cells are obtained from a donor and not from the patient undergoing the stem cell transplant. The HCPCS codes describing autologous stem cell processing procedures also may be billed and are separately payable under the OPPS when provided to hospital outpatients. Payment for autologous stem cell harvesting procedures performed in the hospital inpatient setting of care, with transplant also occurring in the inpatient setting of care, is included in the MS-DRG payment for the autologous stem cell transplant.