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Hematopoietic Cell Transplantation for Autoimmune Diseases
Blue Cross & Blue Shield of Mississippi·MS · Rheumatology, Oncology, Hematology +2 more·Medical Policy
We identified it
Jun 20, 2026
Summary
Blue Cross & Blue Shield of Mississippi updated their policy on hematopoietic cell transplantation for autoimmune diseases. Autologous HCT is now considered medically necessary for systemic sclerosis (scleroderma) under specific criteria, while HCT for other autoimmune diseases like multiple sclerosis, lupus, and rheumatoid arthritis remains investigational. Prior authorization through Case Management is required for all transplant procedures and evaluations.
Action Required
Immediately: Billing team must ensure prior authorization through Case Management is obtained before billing any hematopoietic cell transplantation procedures or evaluations for BCBS Mississippi members. Update system to flag systemic sclerosis patients for medical necessity criteria verification (age <60, disease duration <5 years, modified Rodnan skin score ≥15, organ involvement, <6 months cyclophosphamide treatment). Claims will be denied without prior authorization.