CurrentBlue Shield of CaliforniaPolicy 8.01.24

Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults

Customize your policy alerts

Sign up for blue_shield_of_california Policy 8.01.24 alerts

Get alerted when Policy 8.01.24 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

This policy governs coverage consideration for autologous or allogeneic hematopoietic cell transplantation in adults with specified miscellaneous solid tumors. The listed transplant services are considered investigational for these malignancies.

Policy Summary

PayerBlue Shield of California

PolicyHematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults

Policy CodePolicy N/A

Change TypeAnnual reviewno material coverage change

Effective DateMarch 1, 2026

Next Review DateN/A

Key ActionSubmit the completed transplant evaluation, including clinical history, applicable consultation reports, and donor identification when available.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

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.

CurrentBlue Shield of CaliforniaPolicy 8.01.24

Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults

Customize your policy alerts

Sign up for blue_shield_of_california Policy 8.01.24 alerts

Get alerted when Policy 8.01.24 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerBlue Shield of California

PolicyHematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults

Policy CodePolicy N/A

Change TypeAnnual reviewno material coverage change

Effective DateMarch 1, 2026

Next Review DateN/A

Key ActionSubmit the completed transplant evaluation, including clinical history, applicable consultation reports, and donor identification when available.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

21Adult solid-tumor malignancies considered investigational

2HCT types addressed

Insufficient evidenceEvidence conclusion

15CPT and HCPCS codes listed

Investigational Coverage Criteria

Investigational Indications

Autologous or allogeneic hematopoietic cell transplantation is considered investigational when performed for any of the following adult malignancies.

Specified miscellaneous solid tumors: The malignancy is one of the following: bile duct cancer; fallopian tube cancer; cervical cancer; colon cancer; esophageal cancer; gallbladder cancer; lung cancer of any histology; malignant melanoma; nasopharyngeal cancer; neuroendocrine tumors; pancreatic cancer; paranasal sinus cancer; prostate cancer; rectal cancer; renal cell cancer; soft tissue sarcomas; stomach cancer; thyroid tumors; tumors of the thymus; tumors of unknown primary origin; or uterine cancer.

Either autologous or allogeneic HCT is considered investigational for these malignancies.

Allogeneic HCT in Nasopharyngeal Cancer

Evidence conclusion for allogeneic HCT in nasopharyngeal cancer.

Insufficient evidence: Current evidence is insufficient to conclude whether allogeneic hematopoietic cell transplantation improves overall survival among individuals with nasopharyngeal cancer.

Evidence is based on a phase 2 trial; randomized controlled trials were not available.

Investigational Miscellaneous Solid-Tumor Indications

Autologous or allogeneic hematopoietic cell transplantation is considered investigational when the adult malignancy is any of the following.

Transplant type and malignancy

Transplant type: Autologous or allogeneic hematopoietic cell transplantation
Malignancy: Cancer of the bile duct; cancer of the fallopian tubes; cervical cancer; colon cancer; esophageal cancer; gallbladder cancer; lung cancer of any histology; malignant melanoma; nasopharyngeal cancer; neuroendocrine tumors; pancreatic cancer; paranasal sinus cancer; prostate cancer; rectal cancer; renal cell cancer; soft tissue sarcomas; stomach cancer; thyroid tumors; tumors of the thymus; tumors of unknown primary origin; or uterine cancer.
Any one of the listed malignancies qualifies as an investigational indication.

Transplant Candidate Criteria

Miscellaneous Solid-Tumor Transplant Indications

Candidate malignancy criteria under this policy identify transplantation as investigational rather than establishing a covered candidate pathway.

Adult miscellaneous solid tumors: The patient is an adult with one of the malignancies listed in the policy statement.

Autologous or allogeneic hematopoietic cell transplantation is considered investigational for the listed malignancies.

Adult Miscellaneous Solid-Tumor Transplant Candidates

For adults with one of the specified miscellaneous solid tumors, autologous or allogeneic hematopoietic cell transplantation is considered investigational.

Investigational transplant candidate condition: The adult malignancy is cancer of the bile duct, cancer of the fallopian tubes, cervical cancer, colon cancer, esophageal cancer, gallbladder cancer, lung cancer of any histology, malignant melanoma, nasopharyngeal cancer, neuroendocrine tumors, pancreatic cancer, paranasal sinus cancer, prostate cancer, rectal cancer, renal cell cancer, soft tissue sarcomas, stomach cancer, thyroid tumors, tumors of the thymus, tumors of unknown primary origin, or uterine cancer.

Coding and Billing Information

Hematopoietic progenitor cell donor, harvesting, and processing codesCPT

38204	Management of recipient hematopoietic progenitor cell donor search and cell acquisition.
38205	Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; allogeneic.
38206	Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; autologous.
38207	Transplant preparation of hematopoietic progenitor cells; cryopreservation and storage.
38208	Transplant preparation of hematopoietic progenitor cells; thawing of previously frozen harvest, without washing, per donor.
38209	Transplant preparation of hematopoietic progenitor cells; thawing of previously frozen harvest, with washing, per donor.
38210	Transplant preparation of hematopoietic progenitor cells; specific cell depletion within harvest, T-cell depletion.
38211	Transplant preparation of hematopoietic progenitor cells; tumor cell depletion.
38212	Transplant preparation of hematopoietic progenitor cells; red blood cell removal.
38213	Transplant preparation of hematopoietic progenitor cells; platelet depletion.

1–10 of 11

1/2

CPTCPT

38204	Management of recipient hematopoietic progenitor cell donor search and cell acquisition.
38205	Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; allogeneic.
38206	Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; autologous.
38207	Transplant preparation of hematopoietic progenitor cells; cryopreservation and storage.
38208	Transplant preparation of hematopoietic progenitor cells; thawing of previously frozen harvest, without washing, per donor.
38209	Transplant preparation of hematopoietic progenitor cells; thawing of previously frozen harvest, with washing, per donor.
38210	Transplant preparation of hematopoietic progenitor cells; specific cell depletion within harvest, T-cell depletion.
38211	Transplant preparation of hematopoietic progenitor cells; tumor cell depletion.
38212	Transplant preparation of hematopoietic progenitor cells; red blood cell removal.
38213	Transplant preparation of hematopoietic progenitor cells; platelet depletion.

1–10 of 14

1/2

HCPCSHCPCS

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 posttransplant care in the global definition.

Documentation and Provider Actions

Documentation Required

Provider and Transplant Consultation Records

Submit the referring provider’s history and physical, along with the bone marrow transplant consultation report and/or progress notes. Include the diagnosis and staging, prognosis, alternative treatments performed and their results, the specific transplant type requested, and any surgical consultation report or progress notes.

Referring provider history and physical
Bone marrow transplant consultation report and/or progress notes
Diagnosis, including disease staging, and prognosis
Synopsis of alternative treatments performed and results
Specific transplant type being requested
Surgical consultation report and/or progress notes

Documentation Required

Completed Transplant Evaluation

Provide results of the completed transplant evaluation and all related clinical documentation needed to assess transplant candidacy.

Transplant Evaluation Requirements

Documentation Required

Complete the evaluation documentation

Before requesting transplant, submit the completed transplant evaluation and supporting clinical documentation. Include the clinical history, specific issues identified during evaluation, applicable consultation reports or referring-provider correspondence, psychosocial and indicated psychiatric assessment, radiology, cardiopulmonary, pathology, and laboratory reports, and donor identification when information is available for an allogeneic related bone marrow or stem cell transplant.

Clinical Background

Hematopoietic cell transplantation (HCT) restores bone marrow and immune function after intensive, marrow-toxic chemotherapy, with or without whole-body radiotherapy. The infused stem cells may come from the patient (autologous HCT) or a donor (allogeneic HCT). Autologous HCT supports marrow repopulation after treatment, while allogeneic HCT also may provide a graft-versus-malignancy effect but requires immunosuppression and carries risks such as graft-versus-host disease, infection, and organ toxicity.

Transplant and Evidence Definitions

Hematopoietic cell transplantation (HCT)

ProcedureHematopoietic stem cells are intravenously infused to restore bone marrow and immune function after cancer treatment involving bone marrow-toxic cytotoxic drugs, with or without whole-body radiotherapy.

Cell sourceStem cells may be obtained from the transplant recipient or from a donor.

Collection sourcesStem cells may be harvested from bone marrow, peripheral blood, or umbilical cord blood shortly after delivery of neonates.

Autologous HCT

DefinitionAutologous HCT uses hematopoietic stem cells obtained from the transplant recipient.

CompatibilityImmunologic compatibility between the infused stem cells and the recipient is not an issue in autologous HCT.

Policy Summary

PayerBlue Shield of California

PolicyHematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults

Policy CodePolicy N/A

Change TypeAnnual reviewno material coverage change

Effective DateMarch 1, 2026

Next Review DateN/A

Key ActionSubmit the completed transplant evaluation, including clinical history, applicable consultation reports, and donor identification when available.

SourceLink

On This Page

This applies to autologous or allogeneic hematopoietic cell transplantation.

Clinical history
Specific issues identified during the transplant evaluation
Consultation reports or letters, when applicable
Correspondence from referring providers, when applicable

Documentation Required

Psychosocial Evaluation

Submit medical social service or social worker and/or psychiatric evaluations when indicated, including a psychosocial assessment or impression of the patient’s ability to be an adequate transplant candidate.

Medical social service or social worker evaluation
Psychiatric evaluation when issues are noted
Psychosocial assessment or impression of transplant candidacy

Documentation Required

Radiology Reports

Provide radiology reports relevant to the transplant evaluation.

Chest x-ray (CXR)
PET scan, as appropriate
CT scan, as appropriate
Bone survey, as appropriate

Documentation Required

Cardiopulmonary Testing

Submit cardiology procedures and pulmonary function reports completed as part of the transplant evaluation.

EKG
Echocardiogram
Pulmonary function tests (PFTs)

Documentation Required

Pathology and Laboratory Reports

Provide pathology and laboratory documentation supporting the transplant evaluation.

Biopsy and pathology reports
Bone marrow biopsy
Lymph node biopsy, as appropriate
Laboratory reports

Documentation Required

Transplant Evaluation and Donor Information

Provide the completed transplant evaluation and related clinical history, consultations, and donor information for the requested transplant.

Completed transplant evaluation
Clinical history and identified evaluation issues
Consultation reports or letters, when applicable
Identification of a donor for an allogeneic related bone marrow or stem cell transplant, when information is available

Documentation Required

Psychosocial Assessment

Include psychosocial documentation from medical social service, a social worker, or psychiatry when indicated to support the assessment of transplant candidacy.

Medical social service or social worker evaluation
Psychiatric evaluation when issues are noted
Psychosocial assessment or impression of the patient’s ability to be an adequate transplant candidate

Documentation Required

Radiology Reports

Submit the radiology documentation required for the transplant evaluation.

Chest x-ray (CXR)
PET scan, CT scan, and bone survey, as appropriate

Documentation Required

Cardiopulmonary Reports

Provide cardiology and pulmonary evaluation reports supporting the transplant request.

EKG
Echocardiogram
Pulmonary function tests (PFTs)

Documentation Required

Pathology and Laboratory Reports

Submit pathology and laboratory documentation relevant to the transplant evaluation.

Biopsy and pathology reports
Bone marrow biopsy
Lymph node biopsy, as appropriate
Laboratory reports

Denial Risk

Listed Miscellaneous Solid Tumors

Autologous or allogeneic hematopoietic cell transplantation is considered investigational for adults with the listed miscellaneous solid tumors.

Bile duct cancer
Fallopian tube cancer
Cervical cancer
Colon cancer
Esophageal cancer
Gallbladder cancer
Lung cancer, any histology
Malignant melanoma
Nasopharyngeal cancer
Neuroendocrine tumors
Pancreatic cancer
Paranasal sinus cancer
Prostate cancer
Rectal cancer
Renal cell cancer
Soft tissue sarcomas
Stomach cancer
Thyroid tumors
Tumors of the thymus
Tumors of unknown primary origin
Uterine cancer

Denial Risk

Insufficient Evidence

The evidence is insufficient to determine that autologous or allogeneic hematopoietic cell transplantation improves net health outcomes for the malignancies discussed in the evidence review.

Autologous HCT for soft tissue sarcomas: randomized trials did not establish an overall survival benefit.
Autologous HCT for small cell lung cancer: studies have not reported increased overall survival.
Allogeneic HCT for renal cell carcinoma, colorectal cancer, pancreatic cancer, and nasopharyngeal cancer: evidence is limited to case series.

Denial Risk

Investigational Transplant Indication

Transplantation for the listed adult malignancies is considered investigational under this policy.

Applies to both autologous and allogeneic hematopoietic cell transplantation.
Includes the miscellaneous solid tumors listed in the policy statement.

Cell sourceThe recipient's own hematopoietic stem cells are used for the transplant.

Allogeneic HCT (allo-HCT)

DefinitionAllogeneic HCT uses hematopoietic stem cells from a donor.

CompatibilityDonor-recipient immunologic compatibility is critical and is established through human leukocyte antigen (HLA) typing.

Post-infusion treatmentImmunosuppressant drugs are required after graft infusion to minimize graft rejection and graft-versus-host disease.

Reduced-intensity conditioning (RIC)

DefinitionRIC is pretransplant conditioning using lower doses of cytotoxic drugs or less intense radiotherapy than traditional full-dose myeloablative conditioning.

Treatment goalThe goal is to reduce treatment-related morbidity and nonrelapse mortality while allowing a graft-versus-malignancy effect to develop.

UseRIC is used before allogeneic transplantation and is tailored to the disease and the patient's condition.

Autologous hematopoietic cell transplantation

DefinitionAutologous HCT uses hematopoietic stem cells collected from the patient before bone marrow ablation.

Typical treatment contextIt is typically performed as consolidation therapy when the patient's disease is in complete remission.

Distinctive riskPatients may experience chemotherapy-related toxicities and opportunistic infections before engraftment, but not graft-versus-host disease.

Reduced-intensity conditioning

DefinitionReduced-intensity conditioning uses lower doses of cytotoxic drugs or less intense radiotherapy than traditional full-dose myeloablative conditioning.

DistinctionRIC is intended to be nonmyeloablative, although regimens range from nearly myeloablative to minimally myeloablative with lymphoablation.

PurposeThe approach seeks to minimize treatment-related morbidity and nonrelapse mortality while allowing the graft-versus-malignancy effect to develop.

Allo-HCT

DefinitionAllo-HCT is allogeneic hematopoietic cell transplantation using hematopoietic cells from an allogeneic donor.

Evidence-context terminologyIn the renal cell carcinoma evidence, some patients received grafts from HLA-identical siblings.

Treatment effectThe approach is studied in part for a possible graft-versus-tumor effect.

AbbreviationOS means overall survival.

Outcome measureOverall survival is one of the general outcomes of interest in evaluating hematopoietic cell transplantation.

Follow-upFollow-up over months to years is used to monitor relevant outcomes.

RIC

MeaningRIC means reduced-intensity conditioning used before allo-HCT.

Conditioning approachIt uses lower doses of cytotoxic drugs or less intense radiotherapy than traditional full-dose myeloablative conditioning.

Evidence examplesRIC was used before allo-HCT in reported renal cell carcinoma and metastatic colorectal cancer series.

Autologous stem cell transplantation (AuSCT)

DefinitionAutologous stem cell transplantation is transplantation using the patient's own hematopoietic stem cells.

AbbreviationThe abbreviation is AuSCT.

Coverage contextFor solid tumors other than neuroblastoma, CMS states that insufficient data exist to establish definite conclusions regarding AuSCT efficacy.

Allogeneic hematopoietic cell transplantation (allo-HCT)

DefinitionAllogeneic hematopoietic cell transplantation uses hematopoietic cells from another individual.

Potential donorThe donor may be a sibling or another related donor when applicable.

Clinical terminologyThe procedure is also referred to as allo-HCT.