CurrentCapital BluecrossPolicy MP 9.055

Allogeneic hematopoietic cell transplantation for genetic diseases and acquired anemias

This policy governs when allogeneic hematopoietic cell transplantation (allo‑HCT) is considered medically necessary for selected genetic disorders and acquired anemias for members of Capital BlueCross products, with product-specific variations noted.

Policy Summary

PayerCapital Bluecross

PolicyAllogeneic hematopoietic cell transplantation for genetic diseases and acquired anemias

Policy CodePolicy MP 9.055

Change TypeNo material changes

Effective Date11/1/2025

Next Review DateN/A

Key ActionObtain prior authorization confirming diagnosis, donor HLA match status, and conditioning strategy before scheduling allo‑HCT.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

11/1/2025Policy effective date

MultipleCondition groups listed

~20+ICD-10 diagnoses listed

MultipleProcedure codes referenced

50+

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Coverage Criteria for Allogeneic Hematopoietic Cell Transplantation

inv-01: Medically necessary indications

Allogeneic hematopoietic cell transplantation is considered medically necessary for select patients with the following disorders:

Covered Indication Group: At least one of the following disease groups: hemoglobinopathies (sickle cell disease with prior stroke or increased risk of stroke or end-organ damage; homozygous beta-thalassemia), bone marrow failure syndromes (including hereditary forms such as Fanconi anemia, dyskeratosis congenita, Shwachman-Diamond, Diamond-Blackfan, or acquired aplastic anemia), primary immunodeficiencies (absent or defective T cell, NK cell, or neutrophil function as enumerated), inherited metabolic diseases (selected lysosomal and peroxisomal storage disorders except Hunter, Sanfilippo, and Morquio), and genetic disorders affecting skeletal tissue (infantile malignant osteopetrosis).

See Policy Guideline #1 and #2 for disease-specific lists and details.

inv-02: General coverage criteria for allo-HCT

Covered when ALL of the following are met for applicable disorders:

Indication: Diagnosis of a disorder for which allo-HCT is indicated (eg, hemoglobinopathies such as thalassemia or sickle cell disease meeting disease-specific criteria; bone marrow failure syndromes including Fanconi anemia; primary immunodeficiencies such as severe combined immunodeficiency or Wiskott-Aldrich; specified inherited metabolic lysosomal or peroxisomal storage disorders; and genetic skeletal disorders such as infantile malignant osteopetrosis).

Supported by disease-specific treatment statements (see Policy Guideline sections).

Therapeutic intent: Procedure intended to correct a genetic defect or restore hematopoiesis or immune function where allo-HCT is the only definitive cure or is likely to improve health outcomes.

Documented in disease treatment sections and summary of evidence.

Donor selection and compatibility: An acceptable donor has been identified with HLA compatibility appropriate to the clinical context (eg, HLA-matched sibling or suitable alternative donor per transplant standards).

HLA matching and donor selection are emphasized as critical for successful allo-HCT.

Conditioning strategy and patient fitness: A conditioning regimen (myeloablative or reduced-intensity) has been selected and documented with rationale, and the patient has been assessed as fit for the planned regimen with consideration of comorbidities and transplant risks.

Pretransplant evaluation must include HLA typing and organ-function assessment; RIC defined in policy.

inv-03: Inherited metabolic disease coverage

Covered for inherited metabolic diseases when ALL of the following are met except as noted:

Disease type: Inherited metabolic diseases of lysosomal or peroxisomal storage disorders listed in the policy (eg, Hurler, Krabbe, Gaucher, metachromatic leukodystrophy) for which donor-cell enzyme replacement from engrafted cells can alter disease course.

See Table 1 and Policy Guideline #2 for the full list of metabolic disorders.

Expected benefit: Clinical evidence supports improvement in survival or disease-specific outcomes from allo-HCT for the listed metabolic disorders.

Policy summary of evidence supports benefit for many listed disorders but notes exceptions below.

Exceptions (not supported for neurologic benefit): Hunter, Sanfilippo, and Morquio syndromes are exceptions: allo-HCT has not demonstrated improvement in neurologic, neuropsychologic, or neurophysiologic function for these syndromes and evidence is insufficient to determine net health benefit.

These syndromes are excluded from metabolic-disease indications per policy evidence summary.

Allogeneic hematopoietic cell transplantation (allo‑HCT) is not considered effective for Hunter, Sanfilippo, or Morquio syndromes and these conditions are explicitly excluded from the inherited metabolic disease indications of this policy.

The policy rationale is based on available evidence showing that use of allo‑HCT in Hunter, Sanfilippo, and Morquio syndromes does not produce improvements in neurologic, neuropsychologic, or neurophysiologic function; the evidence for clinical benefit in these syndromes is insufficient to support use.

Listing a procedure or diagnosis code in the policy coding section does not denote coverage. Coverage and payment decisions remain subject to the member's benefit terms, eligibility on the date of service, and a determination that the service is medically necessary and appropriate.

An administrative update dated 09/19/2025 recorded removal of the Benefit Variations section; providers should reference current policy history for details of changes to coding and administrative content.

In summary, evidence for allo‑HCT in certain inherited metabolic disorders is limited: while some lysosomal and peroxisomal disorders show benefit, available data for Hunter, Sanfilippo, and Morquio syndromes do not demonstrate neurologic or neurocognitive improvement and are therefore considered insufficient to support transplantation for neurologic benefit.

Disease-based Candidate and Selection Criteria

inv-38: Candidate disease categories

Disease-based candidate criteria (patient must have one of the listed conditions to be considered):

Hemoglobinopathies: Sickle cell disease for children or young adults with a history of prior stroke or increased risk of stroke or end-organ damage; homozygous β-thalassemia (thalassemia major).

Sickle cell treatment options include transfusions, hydroxyurea, and allo-HCT (definitive cure).

Bone marrow failure syndromes: Aplastic anemia including hereditary forms (Fanconi anemia, dyskeratosis congenita, Shwachman-Diamond, Diamond-Blackfan) and acquired aplastic anemia where disease progression threatens hematopoiesis or survival.

Fanconi anemia HCT is the only definitive restoration of hematopoiesis.

Primary immunodeficiencies: Absent or defective T cell, NK cell, or neutrophil function disorders as listed (eg, severe combined immunodeficiency, Wiskott-Aldrich syndrome, Chediak-Higashi, Kostmann syndrome, chronic granulomatous disease, leukocyte adhesion defect).

Contraindications and Fitness for Transplant

Documented contraindications are not included in the excerpted policy content provided here; refer to the full policy document or institutional transplant guidelines for an explicit list of contraindications.

Patients who are not medically fit to tolerate myeloablative conditioning are at higher risk for transplant‑related morbidity and mortality; conditioning intensity must be tailored to patient fitness and comorbidities, and those unable to tolerate intensive regimens may require consideration of alternative strategies or may be unsuitable candidates for myeloablative allo‑HCT.

Pretransplant Evaluation and Assessment Requirements

Prior Authorization

Prior Authorization Required

Prior authorization is required for allogeneic hematopoietic cell transplantation (allo‑HCT) when the procedure matches covered indications in this policy. Providers must obtain prior authorization before scheduling allo‑HCT and submit the required clinical documentation to support medical necessity.

Prior authorization required for allo‑HCT and when matching covered indications
Prior authorization applies to listed procedure codes (see coding and documentation note)
Product‑specific coverage and coding guidance must be followed

Documentation Required

Pretransplant Clinical Indications and Documentation

Before authorization, providers must document the clinical indication and required pretransplant evaluation elements: diagnosis and disease‑specific severity, prior therapies (for hemoglobinopathies include hydroxyurea, chronic transfusions and iron chelation as applicable), HLA typing results, organ function assessment (cardiac, pulmonary, hepatic, renal), infectious disease screening, and assessment of graft rejection and graft‑versus‑host disease risk. For inherited metabolic disorders, note that evidence is limited for some conditions; indicate disease‑specific rationale for allo‑HCT.

Provider Actions, Prior Authorization, and Documentation

Prior Authorization

Prior authorization required for covered indications

Prior authorization is expected when the requested allo‑HCT matches the policy's covered indications; authorization decisions depend on matching the patient diagnosis to the policy and product‑specific benefit variations.

Submit PA when the patient's diagnosis corresponds to policy indications
PA outcome may depend on product/program benefit variations

Prior Authorization

PA must confirm indication, HLA match, and conditioning plan

When requesting prior authorization, confirm the clinical indication, donor HLA match status, and the planned conditioning strategy (conventional/myeloablative vs reduced‑intensity).

Document specific diagnosis (eg, thalassemia, sickle cell disease, Fanconi anemia)
Provide HLA compatibility results and donor type
Specify conditioning regimen and rationale (myeloablative vs RIC)

Coding: Procedure and Diagnosis Codes

Covered procedure codes (as listed)CPTCovered

38204	Procedure code listed in policy coding section
38205	Procedure code listed in policy coding section
38208	Procedure code listed in policy coding section
38209	Procedure code listed in policy coding section
38210	Procedure code listed in policy coding section
38212	Procedure code listed in policy coding section
38213	Procedure code listed in policy coding section
38214	Procedure code listed in policy coding section
38215	Procedure code listed in policy coding section
38230	Procedure code listed in policy coding section

1–10 of 12

1/2

Covered ICD-10 Codes (diagnoses listed)ICD-10Covered

D56.1	Beta thalassemia
D57.01	Hb-SS disease with acute chest syndrome
D57.02	Hb-SS disease with splenic sequestration
D57.03	Hb-SS disease with cerebral vascular involvement
D57.04	Hb-SS disease with dactylitis
D57.09	Hb-SS disease with other specified complication
D57.1	Sickle-cell disease without crisis
D57.20	Sickle-cell/Hb-C disease without crisis
D57.211	Sickle-cell/Hb-C disease with acute chest syndrome
D57.212	Sickle-cell/Hb-C disease with splenic sequestration

1–10 of 110

1/11

ICD-10-CM codes added in administrative updatesICD-10

E75.244	New code added (document notes new code E75.244 added)
E61.03	New code added (document notes new code E61.03 added)

ICD-10-CM codes revisedICD-10

D57.411	Definition revised (document notes revision of D57.411 and D57.412 definitions; 'unspecified' added)
D57.412	Definition revised (document notes revision of D57.411 and D57.412 definitions; 'unspecified' added)

Coding list completeness

Coding completenessThe policy explicitly notes the listed codes may not be all-inclusive and are subject to change; identification of a code does not denote coverage.

Impact on claimsFinal coverage and payment depend on member benefit terms and eligibility, not solely on code listing.

Provider actionProviders should reference current payer coding when submitting claims and prior authorization requests.

MaintenanceCodes may be revised or added through administrative updates; use the policy history and current coding table for updates.

Background and Rationale

Allogeneic hematopoietic cell transplantation (allo‑HCT) is a potential curative therapy for selected inherited and acquired hematologic and immune disorders, including hemoglobinopathies (eg, sickle cell disease, homozygous β‑thalassemia), bone marrow failure syndromes (eg, Fanconi anemia), primary immunodeficiencies, certain inherited metabolic/storage disorders (select lysosomal and peroxisomal disorders), and some genetic skeletal diseases. Outcomes and applicability vary by disease, age, conditioning intensity, and graft‑related risks; evidence supports meaningful improvement in net health outcome for many, but not all, listed disorders.

Definitions and Terminology

Sickle cell disease — key features

DefinitionSickle cell disease: a hemoglobinopathy caused by a single amino acid substitution in the beta chain of hemoglobin, manifesting with anemia, vaso-occlusive crises, acute chest syndrome, stroke risk, organ dysfunction, and shortened life expectancy.

Typical candidate criteriaConsidered for children or young adults with prior stroke or at increased risk of stroke or end-organ damage (eligible allo-HCT indication).

Therapeutic intentAllo-HCT may be offered as a definitive curative therapy for eligible patients when clinical criteria are met.

Homozygous β-thalassemia (thalassemia major)

DefinitionHomozygous β-thalassemia (thalassemia major): a severe form of thalassemia requiring lifelong transfusions with progressive iron overload and risk of end-organ damage; allo-HCT is the only definitive cure.

Center and Program Requirements

Note

Center accreditation and program variations (not specified here)

The policy does not state explicit center accreditation requirements within this excerpt; product/program variations apply and centers should follow applicable program requirements and referenced society guidance.

Confirm program‑specific center requirements and accreditation expectations (eg, FACT) per product terms

Note

Center requirements: check product/program variations and accreditation

Product/program variations apply to center requirements and accreditation expectations; consult product terms and referenced guidelines to determine whether FACT accreditation or other center qualifications are required.

Verify whether the member's product requires treatment at accredited centers

Note

Center requirements: follow guidelines and payer rules

Post-Transplant Care, Monitoring, and Outcomes

Post-transplant outcomes — variability

Outcome variabilityPost-transplant outcomes vary by underlying disease and conditioning intensity; RIC experience is limited and results are disease-dependent.

Disease-specific differencesBone marrow failure syndromes and primary immunodeficiencies generally show the most promising results; hemoglobinopathies face higher graft rejection and GVHD in adults.

Evidence notePublished reviews and trials cited in the policy inform outcome expectations and ongoing research (see references).

Post-transplant immunosuppressive therapy and monitoring

ImmunosuppressionAfter allo-HCT, immunosuppressant drugs are required to minimize graft rejection and graft-versus-host disease; management follows standard of care.

Policy History and Administrative Updates

2025-09-19administrative_updateLatest

Removed Benefit Variations section and updated the Disclaimer.

2025-08-01consensus_review

Consensus review conducted; no change to policy statement; references reviewed and updated.

2024-08-19consensus_review

Consensus review conducted; no change to the policy statement; references reviewed and updated.

Policy Summary

PayerCapital Bluecross

PolicyAllogeneic hematopoietic cell transplantation for genetic diseases and acquired anemias

Policy CodePolicy MP 9.055

Change TypeNo material changes

Effective Date11/1/2025

Next Review DateN/A

Key ActionObtain prior authorization confirming diagnosis, donor HLA match status, and conditioning strategy before scheduling allo‑HCT.

SourceLink

On This Page

Untreated severe combined immunodeficiency is usually fatal in infancy; HCT is the treatment of choice.

Inherited metabolic and skeletal disorders: Selected lysosomal and peroxisomal storage disorders (excluding Hunter, Sanfilippo, and Morquio) and genetic skeletal disorders such as infantile malignant osteopetrosis (high early mortality without transplant).

Infantile malignant osteopetrosis often leads to death before age 6 without HCT.

inv-39: Transplant candidate considerations

Candidate selection considerations referenced in disease-specific sections:

Bone marrow failure syndromes: Patients with Fanconi anemia, dyskeratosis congenita, Shwachman-Diamond syndrome, or Diamond-Blackfan anemia when progressive marrow failure, cytopenias, or risk of malignant transformation threaten survival; HCT is the definitive therapy to restore hematopoiesis.

Fanconi anemia associated with genomic instability and high risk of marrow failure and malignancy; median survival historically limited.

Primary immunodeficiencies: Severe combined immunodeficiency and other severe primary immunodeficiencies (eg, Wiskott-Aldrich) where HCT is the treatment of choice because affected patients have poor prognosis without transplant (eg, untreated SCID usually fatal by 12–18 months).

Timely HCT critical given poor natural history without transplant.

Genetic skeletal disorders: Infantile malignant osteopetrosis patients with marrow failure, rapid disease progression, and high early mortality; HCT is the curative option and indicated when clinical course predicts deterioration without transplant.

Approximately 70% of infantile malignant osteopetrosis patients die before age 6 without transplant.

Clinical indication documentation: diagnosis, disease severity, and rationale for allo‑HCT
Required clinical documentation: prior therapies (hemoglobinopathies), HLA typing, organ function testing, infectious workup, GVHD / graft rejection risk assessment
Document product‑specific coverage considerations where applicable

Billing Rule

Coding, Billing, and Prior Authorization

Coding and billing must reflect prior authorization expectations. Providers should include relevant CPT/HCPCS/ICD‑10 procedure and diagnosis codes on authorization requests and claims. Prior authorization is implied for listed procedure codes and is required before service; failure to preauthorize may result in claim denial. Policy history and administrative documents may include additional coding updates—review policy history when preparing requests.

Coding and prior authorization: include procedure and diagnosis codes on prior authorization requests
Prior authorization implied for applicable procedure codes — obtain approval before performing allo‑HCT
Policy history may document administrative coding changes affecting submission

Note

Evidence and Policy Notes

Evidence considerations: allo‑HCT is a definitive curative option for selected disorders (eg, thalassemia, selected inherited metabolic disorders) but evidence is limited for many metabolic conditions. No changes to policy statements were recommended in the recent review; continue to follow existing coverage criteria. When the indication is rare or evidence is limited, provide disease‑specific supportive literature and rationale with the prior authorization request.

Limited evidence for specific metabolic disorders — include disease‑specific rationale in authorization request
No policy statement changes recommended in recent review; follow established criteria
Therapy sequence context: document prior treatments and where allo‑HCT fits in treatment algorithm (eg, sequence after transfusions/hydroxyurea for hemoglobinopathies)

Billing Rule

Include transplant procedure codes with PA requests

Transplant‑related CPT/HCPCS procedure codes listed in the policy are associated with prior authorization processes; include these codes when initiating authorization and claims submissions.

CPT codes listed include 38204, 38205, 38208, 38209, 38210, 38212, 38213, 38214, 38215, 38230, 38240, 38242

Prior Authorization

Reference current policy codes for PA and claims

Administrative updates have added and revised ICD‑10‑CM codes; prior authorization and claims must reference the current policy code lists to avoid processing issues.

Use the policy's current ICD‑10 coding when submitting PA and claims

Step Therapy

Document prior therapies in treatment sequence

Document prior standard therapies for conditions like sickle cell disease (eg, chronic transfusions, hydroxyurea) because these therapies are recognized treatment options and part of the therapeutic sequence.

Record history of chronic transfusions or hydroxyurea when applicable

Step Therapy

Record prior therapies for hemoglobinopathies

For hemoglobinopathies, document alternative therapies attempted (for example, transfusions and hydroxyurea for sickle cell disease) as this history may be expected when evaluating suitability for allo‑HCT.

Provide details of transfusion history, hydroxyurea use, and response

Note

Provider action (see PA and documentation guidance)

Placeholder — follow the policy's guidance and submit required clinical information with prior authorization requests per payer instructions.

Include relevant coding and clinical details

Note

Provider action (attach disease evidence as needed)

Placeholder — ensure submissions follow payer processes and include disease‑specific supporting evidence when applicable.

Attach disease‑specific evidence or guideline citations when relevant

Documentation Required

Document clinical indication and supporting criteria

Document the diagnosis and supporting clinical indications demonstrating the patient meets the policy's medical necessity criteria for allo‑HCT.

State which covered indication the patient meets (eg, hemoglobinopathy, bone marrow failure, primary immunodeficiency, inherited metabolic disorder)

Documentation Required

Required documentation: diagnosis, HLA results, conditioning details

Include disease diagnosis, HLA compatibility testing results, and the conditioning regimen details (myeloablative vs reduced‑intensity) in the clinical record and with PA submissions.

Attach HLA typing results and donor match level
Specify conditioning agents/regimen and rationale

Billing Rule

Coding note: reference policy codes; list not exhaustive

When submitting claims, reference the policy's coding section; the list may not be all‑inclusive and the presence of a code in the policy does not guarantee coverage—final determination is based on member contract.

Verify codes against current policy and payer guidance before billing

Billing Rule

Use current codes per policy history and administrative updates

Policy history includes administrative updates adding and revising ICD‑10 codes; providers must use current codes as listed by the payer when submitting claims and authorizations to avoid denials or processing delays.

Review policy history for recent coding changes before submission

Denial Risk

Verify product‑specific coverage to avoid denial

Check product/program benefit variations before submitting an authorization; this policy applies only to certain Capital Blue Cross programs and lack of product coverage may result in denial.

Confirm member's program/product coverage and benefit terms prior to PA submission

Denial Risk

Denial risk: limited evidence in Hunter, Sanfilippo, Morquio

Allo‑HCT lacks evidence of neurologic benefit for Hunter, Sanfilippo, and Morquio syndromes; requests for these indications may be denied based on insufficient evidence.

Anticipate denial risk for transplantation requested to improve neurologic outcomes in these syndromes

Denial Risk

Coverage contingent on member benefits and medical necessity

Coverage and payment are subject to the member's benefit program, eligibility on the date of service, and a determination that services are medically necessary; these policies are not a guarantee of coverage or payment.

Eligibility and benefit limits may affect approval and payment

Note

Administrative review: follow updated coding and guidance

Administrative reviews recorded no changes to policy statements across consensus reviews, with multiple coding updates noted; providers should follow current policy coding and administrative guidance.

Administrative updates have added and revised ICD‑10 codes over time

Clinical contextTransplantation is considered when disease burden and transfusion dependence risk long-term organ injury; conditioning strategy tailored to patient fitness.

Therapeutic intentAllo-HCT aims to correct the genetic defect and restore normal hematopoiesis.

Fanconi anemia — features and risks

DefinitionFanconi anemia: a hereditary bone marrow failure syndrome characterized by genomic instability, congenital anomalies, chromosome breakage, cancer susceptibility, progressive marrow failure, and high risk of myelodysplastic syndrome or acute leukemia.

PrognosisMost patients succumb to complications of severe aplastic anemia, leukemia, or solid tumors; median survival historically ~30 years.

Role of HCTHCT is currently the only treatment that can definitively restore normal hematopoiesis in Fanconi anemia.

HLA matching

DefinitionHLA matching: assessment of donor–recipient compatibility at HLA-A, -B, and -DR loci using cellular, serologic, or molecular techniques to identify acceptable donors.

ImportanceImmunologic compatibility in allogeneic transplantation is a critical factor for successful outcome; acceptable donor will match at all or most loci.

DocumentationHLA typing results should be included in pretransplant evaluation and prior authorization documentation.

Reduced-intensity conditioning (RIC)

DefinitionReduced-intensity conditioning (RIC): pretransplant regimens using lower doses of cytotoxic drugs or less intense radiotherapy than myeloablative conditioning to reduce early toxicity while enabling graft-versus-disease effects.

GoalBalance relapse risk from residual disease against non-relapse mortality by reducing treatment-related morbidity in less fit patients.

Clinical noteExperience with RIC in many listed diseases has been limited and disease-dependent; intensity should be tailored to disease and patient condition.

Allogeneic hematopoietic cell transplantation (HCT)

DefinitionAllogeneic hematopoietic cell transplantation (HCT): transplantation of hematopoietic stem cells from a donor to replace a recipient's defective or deficient hematopoietic system for treatment of genetic diseases and acquired anemias.

Sources of cellsStem cells may be obtained from bone marrow, peripheral blood, or umbilical cord blood.

CompatibilityAllogeneic HCT requires HLA compatibility assessment; immunologic mismatch influences graft-versus-host disease risk and outcomes.

Hematopoietic cell transplantation (HCT) — broader definition and uses

Definition and usesHematopoietic cell transplantation (HCT): allogeneic transplantation of hematopoietic stem cells used to correct or treat inherited metabolic disorders, primary immunodeficiencies, inherited bone marrow failure syndromes, lysosomal storage diseases, and acquired anemias as supported by cited literature.

Evidence baseMultiple references and society guidelines support HCT indications and outcomes across disease categories.

Clinical implicationApplicability and expected outcomes vary by disease, age, conditioning intensity, donor type, and risk of graft rejection or GVHD.

Additional center‑related requirements are not specified in this excerpt; follow payer instructions and cited transplant society guidelines for program standards and quality measures.

Adhere to society guidelines (eg, ASBMT) and payer program requirements

Note

Center requirements references: society guidelines and reviews

References cited in the policy (including ASBMT guidelines and systematic reviews) inform standards for HCT programs and are the basis for disease‑specific indications and evaluation recommendations.

Use cited references to support clinical rationale in PA and documentation

Post-engraftment monitoring should include surveillance for opportunistic infections and organ toxicity related to conditioning and immunosuppression.

DocumentationPretransplant documentation should include intended conditioning regimen (myeloablative vs reduced-intensity) and planned post-transplant immunosuppression strategy.

Long-term outcomes and chimerism studies

Long-term follow-upLong-term outcome and lineage-specific chimerism studies are cited for various diseases and indicate the importance of prolonged follow-up after HCT.

Chimerism studiesLineage-specific chimerism and long-term outcome data inform durability of engraftment and disease-specific benefit (references included).

Clinical implicationPolicy emphasizes need for ongoing monitoring and reliance on literature for disease-specific long-term expectations; specific coverage duration not specified in excerpt.

2024-08-16administrative_update

Added new ICD-10-CM code E61.03 effective 2024-10-01.

2023-08-29administrative_update

Added nine ICD-10-CM new codes effective 2023-10-01.

2023-08-18consensus_review

Consensus review conducted; no change to policy statement; references and coding reviewed.

2022-08-05consensus_review

Consensus review conducted; no change to policy statement; FEP and references updated; coding reviewed with no changes.

2021-10-01administrative_update

New ICD-10-CM code E75.244 added effective 2021-10-01 (recorded 09/08/2021).

2021-02-24consensus_review

Consensus review conducted; no change to policy statement; background and references updated.

2020-10-01administrative_update

Added ICD-10 new codes and revised definitions of D57.411 and D57.412 (added 'unspecified') effective 2020-10-01.

2020-02-28consensus_review

Consensus review and literature review conducted; no changes to policy statements.