Hematopoietic Cell Transplantation for Ovarian Cancer
Customize your policy alerts
Sign up for Aetna Policy 0635 alerts
Get alerted when Policy 0635 changes without checking for updates manually.
Monitor payer policy activity
This policy governs Aetna's medical necessity and investigational determinations for autologous and allogeneic hematopoietic cell transplantation (HCT) in patients with ovarian cancer, including which transplant types and clinical situations are covered or considered experimental.
No material clinical or coverage changes in this revision.
Coverage Criteria — Hematopoietic Cell Transplantation for Ovarian Cancer
Medically Necessary
Aetna considers the following types of hematopoietic cell transplantations medically necessary for treatment of certain ovarian cancers when criteria are met:
Coverage requires prior responsiveness to standard chemotherapy per policy; listed as medically necessary when criteria are met.
Used as consolidation in complete remission per policy.
Tandem autologous HCT in relapse is listed as medically necessary when criteria are met.
Experimental / Investigational
Hematopoietic cell transplantation is considered experimental and investigational in the following scenarios because effectiveness has not been established:
Designated investigational because effectiveness as initial therapy is not established.
Allogeneic HCT for germ cell tumors of the ovary is listed as investigational.
HCT for epithelial ovarian cancers is considered investigational due to insufficient evidence of effectiveness.
This policy addresses hematopoietic cell transplantation (HCT) for ovarian cancer and defines the clinical situations in which HCT is considered medically necessary. Specifically, autologous HCT is recognized as medically necessary when used for: (1) treatment of relapsed germ cell tumors of the ovary that were responsive to standard chemotherapy; (2) consolidation therapy in germ cell tumors of the ovary that are in complete remission; and (3) planned tandem autologous HCT for relapsed germ cell tumors. These scenarios are contingent on documentation that the patient’s clinical course and prior treatment response meet the policy’s selection criteria.
The sections of the document that follow the core coverage statements are primarily reference material. These reference pages compile the clinical studies, registry reports, and guideline sources underlying the policy and do not themselves state additional exclusions or expand the specific medical necessity criteria listed in the policy statements.
Where the policy designates a use as experimental and investigational, it states that effectiveness has not been established; therefore those uses are considered not medically necessary. Examples identified in the policy include: (1) autologous HCT as an initial (first-line) treatment instead of standard-dose chemotherapy for germ cell tumors of the ovary; (2) allogeneic HCT for germ cell tumors of the ovary; and (3) any HCT (autologous or allogeneic) for epithelial ovarian cancers.
The provided Policy History and administrative pages summarize review dates and versioning but do not contain additional explicit not medically necessary statements beyond those already stated in the policy’s Experimental and Investigational section.
Candidate Selection Criteria for Transplant
Candidate criteria for HCT
Candidate selection criteria are implied by the medically necessary scenarios and prior responsiveness to standard therapy.
Responsiveness to standard chemotherapy is required for coverage of autologous HCT in relapse.
Complete remission must be documented when HCT is used for consolidation.
Tandem autologous HCT is permitted for relapse when criteria are met.
Pre-Transplant Evaluation Requirements
Obtain prior authorization for HCT procedure/HCPCS codes
Prior authorization is required for procedure codes for hematopoietic cell transplantation (HCT); covered codes (e.g., CPT 38232, 38241 and HCPCS S2150) are allowed only when the policy's selection criteria for medically necessary HCT are met, and allogeneic transplant CPT codes (e.g., 38205, 38240) are listed as not covered for the indications in this bulletin.
Contraindications and Limitations
The policy and supporting commentary note that allogeneic transplantation is not generally recommended for ovarian cancer in most contexts and is considered developmental or restricted to very specific settings. The document does not list absolute contraindications by name; instead, it limits use of allogeneic HCT based on available evidence, recommending autologous approaches primarily within approved protocols or selected patients.
Provider Actions, Prior Authorization, and Documentation
Obtain prior authorization for HCT procedure codes and confirm selection-criteria eligibility
Prior authorization is required for the listed CPT and HCPCS transplant codes; coverage for the covered codes (e.g., 38232, 38241, S2150) is permitted only when the policy's selection criteria for medical necessity are met.
No specific PA submission instructions in this policy excerpt
The provided document portion does not specify detailed prior authorization procedures or required forms; providers should follow standard Aetna PA submission processes as no PA workflow details are included here.
- No explicit PA submission steps or forms are specified in the cited portions of the policy.
Sequence HCT after standard chemotherapy—document prior therapy and response
HCT is not defined as formal step therapy, but the policy indicates HCT is reserved for after standard chemotherapy (e.g., for relapsed germ cell tumors responsive to standard chemotherapy) or as consolidation in complete remission.
- Do not interpret policy as requiring a formal step-therapy prior authorization pathway; instead document that standard therapy was given and response assessed per medical necessity criteria.
No step therapy rules present in references/administrative sections
No formal step therapy rules are specified in the reference and administrative sections of the provided policy excerpts; administrative/reference material does not impose additional step therapy steps.
- Rely on the clinical selection criteria in the Medical Necessity section rather than any separate step-therapy algorithm in these chunks.
Document indication aligning with medically necessary scenarios
Document that the requested transplant indication matches one of the medically necessary scenarios (e.g., autologous HCT for relapsed germ cell tumor responsive to standard chemotherapy; autologous HCT as consolidation in complete remission; or tandem autologous HCT for relapsed germ cell tumor).
- Include clinical history showing prior chemotherapy regimens and evidence of chemosensitivity or complete remission as applicable.
- Specify whether the request is for autologous versus allogeneic HCT and the clinical rationale tied to the policy's medically necessary scenarios.
Policy history present; no extra documentation steps listed here
Policy history and review dates are provided in the document, but these chunks do not specify any additional required documentation steps beyond clinical indication documentation.
- Note policy last review date (09/13/2023) and effective date (08/16/2002) when referencing policy versioning for prior authorization discussions.
Expect denial for specified experimental/investigational HCT indications
Requests for autologous HCT as initial (first-line) treatment of germ cell tumors of the ovary, any allogeneic HCT for germ cell tumors of the ovary, and any HCT (autologous or allogeneic) for epithelial ovarian cancers are considered experimental/investigational and may be denied.
- If the request is for any of these scenarios, expect an investigational determination and potential denial per the policy.
- Provide evidence if disputing an investigational determination that demonstrates effectiveness beyond the investigational contexts listed.
No additional provider actions specified in these administrative/reference chunks
The chunks cited here contain administrative and reference material only and do not specify additional provider actions or requirements beyond those noted elsewhere in the policy.
- Use clinical sections of the policy (Medical Necessity, Background) for actionable documentation and PA requirements rather than the policy history or references sections.
Procedure and Diagnosis Codes
| 38206-38215 | Bone marrow or stem cell services/procedures. |
| 96401-96549 | Chemotherapy administration. |
| S2150 | Bone marrow or blood-derived stem cells (peripheral or umbilical), allogeneic or autologous, harvesting, transplantation, and related complications; including: pheresis and cell preparation/storage; marrow ablative therapy; drugs, supplies, hospitalization with outpatient follow-up; medical/surgical, diagnostic, emergency, and rehabilitative services; and the number of days of pre- and post-transplant care in the global definition. |
| C56.1-C56.9 | Malignant neoplasm of ovary [relapsed germ cell tumors]. |
| C57.4 | Malignant neoplasm of uterine adnexa, unspecified [relapsed germ cell tumors]. |
Center and Protocol Requirements
Center and coding rules: autologous allowed in protocols; allogeneic generally not recommended
HCPCS and CPT transplant-related codes (including S2150, 38232, 38241) are listed as covered only if selection criteria are met; allogeneic CPT codes 38205 and 38240 are listed as not covered for indications in this bulletin.
Post-Transplant Global Care and Billing
Background and Disease Overview
Ovarian cancer is predominantly an epithelial carcinoma (about 90% of cases), with less common germ cell and stromal tumors. Standard initial management for ovarian cancer is cytoreductive surgery followed typically by platinum- and taxane-based chemotherapy. The policy recognizes that high-dose chemotherapy (HDC) with hematopoietic stem cell support has been studied, but for epithelial ovarian cancer HDC/HCT remains experimental and should be restricted to clinical trials; by contrast, selected uses of autologous HCT have a role in relapsed germ cell tumors responsive to standard chemotherapy.
Definitions
Policy History & References
Policy last reviewed on 09/13/2023.
Policy effective date established as 08/16/2002.
Next scheduled review set for 07/11/2024.
References cited in support of this policy include clinical trials, registry analyses, and reviews of high-dose chemotherapy and stem cell transplantation in ovarian and germ cell tumors. The bibliography lists sources numbered 1 through 41 and includes randomized trials, phase II/III studies, registry reports from the European Group for Blood and Marrow Transplantation, and other relevant oncology literature that underpin the policy’s conclusions.
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.