CurrentCapital BluecrossPolicy MP 9.047

Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer

This policy governs coverage for autologous and allogeneic hematopoietic cell transplantation (HCT) when used to treat advanced-stage epithelial ovarian cancer for Capital BlueCross members and applicable benefit programs.

Policy Summary

PayerCapital Bluecross

PolicyHematopoietic Cell Transplantation for Epithelial Ovarian Cancer

Policy CodePolicy MP 9.047

Change TypeAdministrative update — no material policy changes

Effective Date05/01/2026

Next Review DateN/A

Key ActionObtain prior authorization and verify member benefits when submitting requests for hematopoietic cell transplantation; reference policy MP 9.047.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

5/1/2026Effective date

InvestigationalCoverage stance

51.6%5‑yr survival (reported)

16–21 moPFS (platinum/taxane)

32–57 moOS (platinum/taxane)

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01/14/2026Policy history through

Coverage Determination

Investigational / Not medically necessary

Not covered — investigational

Main policy statement: Autologous and allogeneic hematopoietic cell transplantation are considered investigational to treat advanced-stage epithelial ovarian cancer because evidence is insufficient to demonstrate improved health outcomes compared with standard-dose chemotherapy.

Autologous and allogeneic hematopoietic cell transplantation (HCT) for the treatment of advanced-stage epithelial ovarian cancer is not covered — investigational. Capital BlueCross considers both autologous and allogeneic HCT investigational for this indication because there is insufficient evidence to conclude that HCT improves health outcomes compared with standard-dose chemotherapy. Claims for HCT in this clinical context are subject to denial based on investigational status.

Administrative updates to the policy have been made without changing the coverage statements. On 11/20/2024 an NCCN statement was removed during an administrative update; subsequent consensus reviews (through 01/14/2026) documented updates to background, references, coding review, and disclaimers but no changes to the policy coverage statements or intent.

The evidence base includes randomized trials and observational series; however, randomized trial data have not demonstrated a survival or net health benefit for HCT compared with conventional standard‑dose chemotherapy. Overall outcomes assessed in the evidence — including overall survival, disease‑specific survival, disease status changes, and treatment‑related mortality and morbidity — do not support HCT as improving health outcomes for advanced epithelial ovarian cancer, and the evidence is therefore considered insufficient to establish medical benefit.

Coding and Billing

Investigational when used for treatment of Epithelial Ovarian CancerCPT | HCPCSNot Covered

38205	Collection of hematopoietic progenitor cells; (procedure code listed under investigational section)
38206	(procedure code listed under investigational section)
38207	(procedure code listed under investigational section)
38208	(procedure code listed under investigational section)
38209	(procedure code listed under investigational section)
38210	(procedure code listed under investigational section)
38211	(procedure code listed under investigational section)
38212	(procedure code listed under investigational section)
38213	(procedure code listed under investigational section)
38214	(procedure code listed under investigational section)

1–10 of 18

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Prior Authorization and Provider Requirements

Prior Authorization

Prior Authorization Required

Prior authorization is required for hematopoietic cell transplantation (HCT) services described in this policy. Providers must request authorization through Capital BlueCross prior to scheduling or performing HCT for epithelial ovarian cancer; refer to policy MP 9.047 when submitting requests for authorization or medical review.

Contact Capital BlueCross for prior authorization before HCT for epithelial ovarian cancer
Reference policy MP 9.047 on authorization requests

Denial Risk

Investigational / Denial Risk

Autologous and allogeneic HCT for advanced-stage epithelial ovarian cancer are considered investigational by Capital BlueCross; claims for HCT in this indication are at risk for denial if provided without approval consistent with this policy.

Investigational indication: HCT for epithelial ovarian cancer — denial risk for claims

Clinical Background

Epithelial ovarian cancer is the most common ovarian malignancy and is a leading cause of gynecologic cancer death. Most patients present with advanced‑stage disease and are managed with cytoreductive surgery followed by platinum‑plus‑taxane chemotherapy, which remains the standard first‑line approach. HCT (autologous or allogeneic) has been investigated primarily as a means to permit high‑dose chemotherapy with stem cell support, but its use in adult solid tumors, including ovarian carcinoma, remains largely experimental and is not part of routine standard therapy.

Terminology

Hematopoietic cell transplantation — definition (autologous vs allogeneic)

DefinitionHematopoietic cell transplantation (HCT): infusion of hematopoietic stem cells to restore bone‑marrow function after bone‑marrow–toxic doses of chemotherapy with or without whole‑body radiotherapy.

Autologous HCTStem cells are obtained from the transplant recipient and reinfused to restore marrow function after high‑dose cytotoxic therapy.

Allogeneic HCTStem cells are obtained from a donor (related or unrelated) to reconstitute the recipient's hematopoiesis; may carry risk of graft‑versus‑host disease.

Sources of stem cellsCells may be harvested from bone marrow, peripheral blood, umbilical cord blood, or placenta shortly after delivery.

Cord blood — definition and clinical relevance

Definition

Line of Therapy Guidance

first-line — single top-level node describing first-line therapy context

First-line therapy context

Standard care: First-line therapy for newly diagnosed advanced epithelial ovarian cancer is cytoreductive surgery followed by platinum-plus-taxane chemotherapy (e.g., paclitaxel plus a platinum analogue); hematopoietic cell transplantation has not demonstrated benefit in randomized trials and is not part of standard first-line treatment.

Standard and Studied Regimens

Regimen	Indication / Notes	Coverage Status
Paclitaxel plus a platinum analogue (e.g., cisplatin)
Preferred regimen for newly diagnosed advanced epithelial ovarian cancer; improves progression-free and overall survival compared with prior therapies (PFS ~16–21 months; OS ~32–57 months).
Covered

Regimen	Indication / Notes	Coverage Status
Hematopoietic cell transplantation (autologous or allogeneic) following high‑dose chemotherapy
Studied in randomized trials and registries as a treatment approach after high‑dose chemotherapy for advanced‑stage epithelial ovarian cancer; relevant outcomes include overall survival, disease‑specific survival, and treatment‑related mortality and morbidity. Randomized evidence has not shown benefit compared with conventional standard‑dose chemotherapy.
Not covered (investigational)

Regimen	Indication / Notes	Coverage Status
High‑dose melphalan and other high‑dose chemotherapy regimens with autologous stem cell transplantation
Referenced in randomized trial(s) and registry reports as consolidation or salvage therapy in chemosensitive or relapsed ovarian cancer (e.g., Papadimitriou et al.; EBMT Solid Tumour Registry; other single‑institution and registry series).
Informational (investigational for this indication)

Policy History

2026-01-14Consensus ReviewLatest

Consensus review with no changes to policy intent; disclaimer and references updated.

2025-02-14Consensus Review

Consensus review with no changes to policy statement; background and references updated and coding reviewed with no changes.

2024-11-20Administrative Update

Policy Summary

PayerCapital Bluecross

PolicyHematopoietic Cell Transplantation for Epithelial Ovarian Cancer

Policy CodePolicy MP 9.047

Change TypeAdministrative update — no material policy changes

Effective Date05/01/2026

Next Review DateN/A

Key ActionObtain prior authorization and verify member benefits when submitting requests for hematopoietic cell transplantation; reference policy MP 9.047.

SourceLink

On This Page

Verify authorization prior to providing HCT to avoid claim denials

Documentation Required

Benefit and Coding Verification

Coverage for HCT is subject to member benefit plan terms. Identification of procedure or diagnosis codes in this policy does not imply coverage. Before providing services or submitting claims, verify the member’s benefits, eligibility, and any applicable limits, and confirm whether HCT is a covered benefit for the member’s product.

Verify member benefits and eligibility prior to scheduling HCT
Coding listed in the policy is informational and does not guarantee payment

Note

Standard Therapy Before Considering HCT

Standard therapy for newly diagnosed advanced epithelial ovarian cancer is cytoreductive (debulking) surgery followed by platinum-plus-taxane chemotherapy (e.g., paclitaxel with a platinum analogue such as cisplatin). HCT is not part of standard first-line therapy and should only be considered in the context of approved indications or clinical trials.

Standard first‑line regimen: cytoreductive surgery + platinum and taxane chemotherapy (e.g., paclitaxel + cisplatin)
HCT is not considered standard therapy for epithelial ovarian cancer

Step Therapy

There are no specific step-therapy sequencing requirements for HCT in this policy. Clinical management generally follows standard chemotherapy regimens first; consult the member’s benefit plan and prior authorization requirements for any plan-specific step edits.

No policy-mandated step therapy sequence for HCT
Follow standard chemotherapy treatment pathways and plan-specific utilization rules before HCT

Note

CMS NCD Alignment

Capital BlueCross aligns with federal coverage considerations. References to the Centers for Medicare & Medicaid Services National Coverage Determination (NCD) 110.23 for stem cell transplantation are provided; federal coverage rules (e.g., for Medicare beneficiaries) and NCDs may affect coverage determinations.

Consider CMS NCD 110.23 when reviewing coverage for Medicare members
Federal NCDs may supersede or affect plan-level determinations

Cord blood: umbilical cord and placental blood collected shortly after delivery that serve as an allogeneic source of hematopoietic stem cells.

Immunologic characteristicsCord‑blood stem cells are antigenically 'naïve' and are associated with a lower incidence of rejection or graft‑versus‑host disease compared with other allogeneic sources.

Clinical useCord blood is an alternative donor source for HCT; discussed in detail in policy MP 9.001 (Placental/Umbilical Cord Blood as a Source of Stem Cells).

Hematopoietic cell transplantation (HCT) — definition referencing high‑dose chemotherapy with autologous support as studied for ovarian cancer

Definition in this policy contextHCT refers to administration of high‑dose chemotherapy followed by infusion of hematopoietic stem cells (autologous or allogeneic) to restore marrow function.

Role in ovarian cancer studiesHigh‑dose chemotherapy with autologous stem‑cell support has been studied as consolidation or salvage therapy for chemosensitive or relapsed ovarian carcinoma (randomized trials and registry reports cited).

Evidence summaryDespite trials and registry data (e.g., high‑dose melphalan and autologous SCT), HCT for adult solid tumors including epithelial ovarian cancer remains largely experimental and not established as standard therapy.

Administrative update removed an NCCN statement from the policy.

2024-03-11Consensus Review

Consensus review with no changes to policy statement; background and references updated and coding reviewed with no changes.

2023-02-15Consensus Review

Consensus review with no change to policy statement; background, rationale, and references updated.

2022-02-21Consensus Review

Consensus review with no change to the policy statement; NCCN language and FEP language added and background and references updated.

2021-02-03Consensus Review

Consensus review with no changes to policy statement; references updated.

2020-02-27Consensus Review

Consensus review with no changes to the policy statements; references reviewed.