NCD 110.21: Stem Cell Transplantation
Medicare covers autologous and allogeneic stem cell transplantation (AuSCT, AlloSCT) for specific malignancies and rare conditions with strict criteria. Coverage was expanded in 2016 for myelofibrosis and multiple myeloma.
What's covered
- Autologous SCT for multiple myeloma (newly diagnosed, post-induction)
- AlloSCT for AML in first/second remission, ALL, CML, NHL
- Coverage Evidence Development (CED) for myelofibrosis and sickle cell disease
Coverage criteria
- Performed at approved transplant center
- Patient meets disease-specific eligibility
- For CED indications: trial enrollment required
Exclusions
- AlloSCT for solid tumors generally not covered
- CED studies require enrollment in approved clinical trial
Common denial patterns
- Wrong NCD subindication cited
- Center not on approved list
- Insufficient documentation of disease stage/remission status
Appeal citation
NCD 110.21 (Stem Cell Transplantation), §[specific subindication]. Cite the Medicare Claims Processing Manual Ch. 32, §90.
Frequently asked questions
What does Medicare NCD 110.21 cover?
Medicare covers autologous and allogeneic stem cell transplantation (AuSCT, AlloSCT) for specific malignancies and rare conditions with strict criteria. Coverage was expanded in 2016 for myelofibrosis and multiple myeloma.
What are the coverage criteria?
Performed at approved transplant center; Patient meets disease-specific eligibility; For CED indications: trial enrollment required.
What is excluded?
AlloSCT for solid tumors generally not covered; CED studies require enrollment in approved clinical trial.
How do I cite this NCD in an appeal?
NCD 110.21 (Stem Cell Transplantation), §[specific subindication]. Cite the Medicare Claims Processing Manual Ch. 32, §90.
Sources
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