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Independence Blue CrossCommercial · Coverage · Medical Policy · Hematology, Oncology, Internal Medicine +1 moreHigh impact

11.07.01ae, Hematopoietic Stem Cell Transplantation

Effective date
Feb 1, 2027
Identified
Nov 3, 2026

Summary

Independence Blue Cross is revising its Hematopoietic Stem Cell Transplantation policy effective 02/01/2027. Key changes include reclassifying tandem autologous transplantation for Hodgkin Lymphoma as experimental, removing Durie-Salmon staging criteria from Multiple Myeloma coverage, expanding Omisirge eligibility, removing G-CSF products from this policy (they move to primary drug policies), and removing five G-CSF-related HCPCS codes from coverage under this policy.

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What to do

Action · 6 steps
01Billing team: Update charge entry and claim templates to stop automatically including G-CSF HCPCS codes (C9173, J1442, J1447, J2506, Q5101, Q5110, Q5125, Q5148) under this HSCT policy; confirm these codes will be billed under their primary drug policies instead.
02Providers and clinical staff: Stop ordering tandem autologous HSCT for Hodgkin Lymphoma under the assumption it meets medical necessity—claims without prior authorization will be denied as experimental.
03Get prior authorization before scheduling tandem autologous transplant for Hodgkin Lymphoma.
04Billing team: Remove Durie-Salmon Staging System documentation requirements from prior authorization requests and charge entry notes for Multiple Myeloma autologous/allogeneic HSCT; update prior auth templates to reflect new criteria.
05Providers and prior auth staff: For Omisirge (J3406) requests, confirm documentation now requires verification that no matched related or unrelated donor is available for the individual with hematologic malignancy before approval.
06Billing team: Retain all other HSCT-related CPT codes (38240, 38241, 38204–38208) and non-G-CSF HCPCS codes (J2277, J2562, J2820, J3406, S2140, S2142, C1830) in charge entry; coverage criteria for these services remain active.

Codes mentioned

C9173J1442J1447J2506Q5101Q5110Q5125Q514838240382413820438205382063820738208C1830J2277J2562J2820J3406S2140S2142

Original notice

11.07.01ae, Hematopoietic Stem Cell Transplantation
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
MA11.002n, Hematopoietic Stem Cell TransplantationMediumEffective Apr 1, 2025 · Medical Policy11.07.01aa, Hematopoietic Stem Cell Transplantation (Bone Marrow Transplant)MediumEffective Apr 1, 2025 · Medical PolicyMA11.002q, Hematopoietic Stem Cell TransplantationMediumEffective Oct 1, 2026 · Medical Policy11.07.01ad, Hematopoietic Stem Cell TransplantationMediumEffective Oct 1, 2026 · Medical PolicyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesHematologyOncologyInternal MedicineTransplant SurgeryCode C9173Code J1442Code J1447Code J2506Code Q5101Code Q5110Code Q5125Code Q5148Code 38240Code 38241Code 38204Code 38205Code 38206Code 38207Code 38208Code C1830Code J2277Code J2562Code J2820Code J3406Code S2140Code S2142

Summaries are AI-assisted. Always confirm against the original payer notice.

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