Hematopoietic Cell Transplantation for Breast Cancer (CPB 0507, reviewed 2026-08-06)
Effective date
Not stated in the notice
Identified
Aug 17, 2026
Summary
Aetna considers autologous, tandem and allogeneic hematopoietic cell transplantation for breast cancer experimental, investigational or unproven, because their effectiveness for this indication has not been established. Aetna will cover these transplants when they are performed in a clinical trial sponsored or authorized by the National Cancer Institute (NCI) or the Federal Food and Drug Administration (FDA), and will continue to cover them off-trial when state mandates or other requirements dictate. Four randomized controlled clinical trials showed that autologous hematopoietic cell transplantation was either similar to or more harmful than standard-dose chemotherapy.
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01Billing team: Bill CPT 38205, 38206, 38230, 38241 and HCPCS S2150 for breast cancer only when the transplant is performed in a clinical trial sponsored or authorized by the NCI or the FDA, or off-trial when state mandates or other requirements dictate coverage.
02The policy lists ICD-10 codes C50.011 through C50.929, C79.81 and D05.00 through D05.92 as not covered for the breast cancer indications in this policy.
Summaries are AI-assisted. Always confirm against the original payer notice.
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