ModifiedCignaPolicy 0533
Stem Cell Transplantation: Blood Cancers
This Cigna coverage policy governs medical necessity criteria and coverage stance for autologous and allogeneic hematopoietic stem cell transplantation (HSCT) in various blood cancers and related disorders for members of Cigna-administered health benefit plans.
Policy Summary
PayerCigna
PolicyStem Cell Transplantation: Blood Cancers
Policy CodePolicy 0533
Change TypeAnnual review with material statement additions and revisions
Effective Date12/15/2025
Next Review Date08/15/2026
Key ActionObtain prior authorization with documentation of guideline-based eligibility and HCT center evaluation including organ function and stem cell collection intent.
SourceLink
POLICY UPDATE CHANGES
Added policy statement for mycosis fungoides and Sézary syndrome.
Revised policy statement for recurrent non-Hodgkin lymphoma with chemosensitive disease.
Revised policy statement for primary Central Nervous System lymphoma (PCNSL); note indicates 'No clinical policy statement changes' for an annual review date.
>15distinct disease indications
17procedure codes listed
12/15/2025effective date
08/15/2026next review