CommercialCoverageMedium impact
Autologous Hematopoietic Stem Cell Transplantation (Auto-HSCT) - (Effective Date - 2026-06-15) 7.02.03
Excellus BlueCross BlueShield·Oncology, Hematology, Neurology +2 more·Transplants
Effective date
Jun 15, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has updated their autologous hematopoietic stem cell transplantation (Auto-HSCT) policy effective June 15, 2026, establishing comprehensive medical necessity criteria for blood/plasma cancers, solid tumors, and non-malignant conditions like multiple sclerosis and systemic sclerosis. The policy requires candidates to meet transplanting institution selection criteria, multidisciplinary team evaluation, and specific indication-based criteria with detailed documentation requirements.
Action Required
Before June 15, 2026: Billing and clinical teams must review and implement new Auto-HSCT coverage criteria for Excellus BCBS members. Update prior authorization processes to verify patients meet specific age, disease state, and clinical criteria outlined in policy 7.02.03. Ensure multidisciplinary team documentation includes all required elements: clinical evaluation, psycho-social assessment, performance status, oral health evaluation, lab tests, cardiac and pulmonary assessments, and age-appropriate screenings. Claims for Auto-HSCT procedures that don't meet the new criteria will be considered investigational and may be denied.