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AetnaAll Plans · Coverage · Medical Policy · Oncology, HematologyMedium impact

Hematopoietic Cell Transplantation for Testicular Cancer (CPB 0617, reviewed 2026-09-03)

Effective date
Not stated in the notice
Identified
Oct 4, 2026

Summary

Aetna's Clinical Policy Bulletin 0617 covers hematopoietic cell transplantation for testicular cancer. Autologous transplant is medically necessary when criteria are met for patients who do not reach complete remission after an initial course of standard-dose chemotherapy (refractory disease or a partial response), as consolidation therapy after relapse following that course, or as tandem autologous transplant for relapsed disease. Autologous transplant as initial treatment in place of standard-dose chemotherapy with FDA-approved drugs, and allogeneic transplant for testicular cancer, are considered experimental, investigational or unproven.

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What to do

Action · 5 steps
01Billing team: For autologous transplant for testicular cancer, confirm the record documents that the criteria are met: refractory disease (less than 50% reduction in tumor burden) or partial response (at least 50% reduction) after an initial course of standard-dose chemotherapy, consolidation after relapse following that course, or tandem autologous transplant for relapsed disease.
02Autologous transplant as initial treatment and allogeneic transplant for testicular cancer are considered experimental, investigational or unproven, so do not expect coverage for them.
03CPT 38205, 38230 and 38240 are not covered for the indications listed in the policy.
04CPT 38206 through 38230, CPT 38241, CPT 96401 through 96549, HCPCS S2150, and ICD-10 codes C62.00 through C62.92 and D07.69 are covered if the selection criteria are met.
05Check the current applicability of this policy before relying on it; the policy lists its next review as 07/08/2027.

Codes mentioned

38205382063823038240382419640196549S2150C62.00C62.92D07.69

Original notice

Hematopoietic Cell Transplantation for Testicular Cancer (CPB 0617, reviewed 2026-09-03)
aetna.com · Always check the source before changing claims.
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Related policy hubs

Aetna policiesOncologyHematologyCode 38205Code 38206Code 38230Code 38240Code 38241Code 96401Code 96549Code S2150Code C62.00Code C62.92Code D07.69

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