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Non-myeloablative Hematopoietic Cell Transplantation (Mini-Allograft / Reduced Intensity Conditioning Transplant) (CPB 0634, reviewed 2026-09-25)

Aetna·Hematology, Oncology, Transplant Surgery·Medical Policy
Effective date
Not stated
We identified it
Oct 6, 2026
Days to comply
—

Summary

This is a policy review of Aetna's CPB 0634 for non-myeloablative hematopoietic cell transplantation (mini-allograft). The policy was reviewed on 2026-09-25 but the document provided contains the full policy text without identifying specific changes from a prior version. The policy establishes medical necessity criteria for mini-allograft procedures in specified hematologic malignancies and bone marrow failure syndromes, while designating other indications as experimental/investigational.

Action Required

Action needed
Verify current applicability of this policy with Aetna, as the review date (2026-09-25) indicates this is an active policy but no specific effective date for changes is stated in the source material. Billing team should: (1) Confirm whether this CPB 0634 review resulted in coverage or documentation changes from the prior version; (2) Audit current authorizations and denials for mini-allograft procedures using the listed CPT/HCPCS codes (38204–38215, 38230, 38240, 38242, S2150) to ensure they align with the stated medical necessity indications (ALL, AML, aplastic anemia, CLL, CML, Hodgkin's disease, multiple myeloma, myelofibrosis, myelodysplasia, neuroblastoma, NHL, sickle cell anemia, thalassemia major); (3) Confirm that procedures for experimental indications (breast cancer, melanoma, ovarian cancer, renal cancer, testicular cancer, autoimmune diseases, essential thrombocythemia, polycythemia vera, acquired angioedema) are being flagged for prior authorization review or denial per policy; (4) Review related CPB policies (0494, 0495, 0496, 0497, 0507, 0606, 0617, 0626, 0627, 0635, 0640, 0674, 0811, 0836, 0838) to verify coordination of mini-allograft coverage across disease-specific policies.

Affected Billing Codes

38204
38205
38207
38208
38209
38210
38211
38212
38213
38214
38215
38230
38240
38242
S2150
J7502
J7515
J7516
J7517
J7528
J8610
J8611
J8612
J9185
J9255
J9260