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Autotransfusers Clinical Policy Bulletin
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Defines Aetna's medical necessity criteria for autotransfusion and cell saver devices, lists covered CPT/HCPCS/ICD-10 codes when selection criteria are met, describes indications considered medically necessary vs experimental/investigational, and provides clinical background and evidence summary. This is Part 1 of 2 of the bulletin.
No material clinical or coverage changes identified (has_material_change=false).
Coverage Summary
Overview: This policy (Policy Number 0639) on Autotransfusers (cell salvage/autotransfusion devices) defines Aetna's medical necessity criteria as mixed (some indications medically necessary; others investigational). Effective date: 2002-08-20; Last review: 2023-09-13; Next review: 2024-07-11.
Indications and thresholds: There are 3 medically necessary indication categories (emergency/intra-operative autotransfusion; hemodilution/cell washing autotransfusion; post-operative autotransfusion, usually within 2 hours). Devices are not considered medically necessary for procedures expected to require < 2 units of blood; the expected transfusion volume threshold for consideration is >= 2 units.
Medical Necessity
Medical Necessity
Aetna considers the following autotransfusion and cell saver devices medically necessary for procedures that may deplete blood volume:
ANY of the following
- Emergency or intra-operative autotransfusion, where blood is collected from the wound or a body cavity, processed, and then returned to the individual.
- Hemodilution or cell washing autotransfusion, where blood is collected and simultaneously replaced with sufficient volume of crystalloid or colloid solution.
- Post-operative autotransfusion (usually done within 2 hours with a chest tube collection device), where the blood from the chest (or other sterile operative sites) is re-infused following heart surgery and traumatic hemithorax.2 hours
Coding
| D62 | Acute posthemorrhagic anemia. |
| O00.00 - O00.91 | Ectopic pregnancy. |
| O08.1 | Delayed or excessive hemorrhage following ectopic and molar pregnancy. |
| O44.10 - O44.13 | Placenta previa with hemorrhage. |
| O45.001 - O45.099 | Premature separation of placenta with coagulation defect. |
| O46.001 - O46.099 | Antepartum hemorrhage with coagulation defect. |
| O67.0 | Intrapartum hemorrhage with coagulation defect. |
| O72.0 | Third-stage hemorrhage. |
| O72.1 | Other immediate postpartum hemorrhage. |
| O72.2 | Delayed and secondary postpartum hemorrhage. |
Provider Actions & Billing Impact
Selection criteria must be met for CPT coverage
CPT codes 86890 and 86891 are covered only if the policy's selection/medical necessity criteria are met — e.g., for procedures likely to deplete blood volume or when the procedure is expected to require ≥2 units of blood or for one of the listed indications.
Indication documentation
Document the clinical indication (for example: emergency or intra-operative salvage, hemodilution/cell washing, or post-operative chest-tube reinfusion after cardiac surgery or traumatic hemithorax) and document estimated blood loss and the anticipated need for transfusion to support medical necessity.
Denial risk for low expected blood loss
Claims may be denied when autotransfusion/cell saver use is for procedures expected to require less than 2 units of blood or for indications considered experimental or investigational (i.e., not among the policy’s listed medically necessary indications).
Policy review and references available
Refer to Aetna's Clinical Policy Bulletin (Policy Number 0639) and the cited literature (systematic reviews, randomized trials, and other references listed in the bulletin) for full policy details and supporting evidence; the bulletin is maintained and periodically updated by Aetna.
Background & Evidence Summary
Background: Autotransfusers (cell salvage or "cell saver" devices) mechanically collect and re-infuse a patient’s own blood lost during surgery; modalities include intra-operative/emergency salvage, post-operative salvage (often reinfused within 2 hours using chest tube collection devices) and hemodilution/cell-washing techniques.
Contraindications and mitigation: Autotransfusion is contraindicated when collected blood is exposed to bacteria (e.g., infected wounds, fecal contamination) or contains malignant cells. Limited studies note that leukocyte depletion filters or blood irradiation may mitigate tumor cell contamination risk, but evidence is limited and use in oncologic or contaminated fields requires caution.
Evidence summary: Systematic reviews and randomized trials (meta-analyses in cardiac and other surgeries) demonstrate that cell salvage generally reduces exposure to allogeneic blood in many settings (cardiac, orthopedic, vascular, some joint and spine procedures) though effects on mortality and major complications are not shown; overall evidence quality is low to moderate with heterogeneous results and mixed cost-effectiveness depending on procedure and setting.
| Citation | Key finding |
|---|---|
| Huet et al (1999) meta-analysis | |
| Cell salvage devices decrease the proportion of patients receiving peri-operative allogeneic transfusion; mixed results for unwashed post-operative devices in cardiac surgery. | |
| Cochrane (Carless et al, 2003) | |
| Cell salvage reduces the need for donated blood but more research needed on cost-effectiveness across surgical settings. | |
| Wang et al (2009) meta-analysis (cardiac) | |
| Reduced exposure to allogeneic blood (OR 0.63) and RBCs (OR 0.60); no difference in mortality or major complications. | |
| Kinnear 2018 cohort | |
| In open radical prostatectomy cohort, ICS did not change allogeneic transfusion rates or recurrence but reduced transfusion-related costs by fewer units transfused. | |
| Kinnear 2019 systematic review | |
| 14 observational studies: ICS reduced allogeneic transfusion in prostatectomy studies (OR 0.34 vs no technique); heterogeneity limited conclusions on recurrence, complications, cost. | |
| So-Osman et al (2014a) randomized study | |
| Autologous reinfusion did not reduce RBC use in hip/knee patients with Hb 10–13 g/dL and increased costs. | |
| So-Osman et al (2014b) large randomized study | |
| In elective total hip/knee patients with pre-op Hb >13 g/dL, autologous salvage devices did not reduce RBC use and increased costs. | |
| Ji et al (2017) meta-analysis (TKA/THA) | |
| Post-operative autotransfusion reduced allogeneic transfusion vs regular drainage in TKA and THA, but not when compared with no drainage; results limited by heterogeneity. | |
| Waters et al (2012) meta-analysis (cancer surgery) | |
| Pooled OR 0.65 suggested intraoperative blood salvage outcomes not inferior to allogeneic transfusion; prospective randomized trials needed to confirm risk in cancer surgery. |
Revision History
Policy effective date
Last review date
Next scheduled review date
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