CommercialPrior AuthMedium impact
Hematopoietic Cell Transplantation for CNS Embryonal Tumors and Ependymoma
Blue Cross & Blue Shield of Mississippi·MS · Oncology, Hematology, Neurosurgery +1 more·Medical Policy
We identified it
Jun 20, 2026
Summary
Blue Cross Blue Shield of Mississippi updated their policy for hematopoietic cell transplantation (HCT) for brain tumors in children. Autologous HCT may be considered medically necessary for recurrent CNS embryonal tumors and as consolidation therapy for previously untreated cases, but all transplant procedures require prior authorization through Case Management.
Action Required
Immediately: Billing team must ensure prior authorization is obtained through Blue Cross Blue Shield of Mississippi Case Management before submitting claims for any hematopoietic cell transplantation procedures for CNS embryonal tumors or ependymoma. Update system alerts to flag these cases for prior auth. Claims will be denied without proper authorization.