Umbilical Cord Blood Harvesting and Storage for Future Use (for New Jersey Only)
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Governs prophylactic collection and cryogenic storage of umbilical cord blood for potential future autologous or allogeneic transplant use; applies only to New Jersey UnitedHealthcare Community Plan members.
No material clinical or coverage changes in this revision.
Coverage Criteria
Prophylactic collection and storage — Not medically necessary
Not covered when the following applies
ASTCT recommends public banking when possible; storage for personal use is not recommended. Directed family banking is recommended when there is a known full sibling with a disease treatable by allogeneic transplant; family banking for a parent is recommended only with shared HLA antigens.
Directed (family) collection and storage of umbilical cord blood is recommended when there is a known full sibling with a disease that may be successfully treated with an allogeneic hematopoietic stem cell transplant. Clinical guidance from the American Society for Transplantation and Cellular Therapy (ASTCT) supports collecting and storing cord blood for a family member in this circumstance, and ACOG similarly advises that directed cord blood banking should be encouraged when a full sibling has a medical condition likely to benefit from cord blood transplant.
When submitting requests or claims for directed collection and storage, include the applicable procedure codes and documentation showing the affected sibling’s diagnosis and the clinical rationale for anticipated allogeneic transplant use as described in the member’s medical record.
Prophylactic collection and private storage of umbilical cord blood for an otherwise healthy individual who desires potential, unspecified future autologous or allogeneic transplantation is considered not medically necessary due to insufficient evidence of benefit. UnitedHealthcare’s coverage rationale states that prophylactic banking for low‑risk families is unproven and not covered.
Professional societies cited in this policy echo this stance: ACOG advises against routine private banking and recommends providing balanced counseling to parents, and ASTCT recommends public banking while discouraging storage for personal use except when directed for a family member with an established indication.
Applicable Procedure Codes
Provider Actions and Billing
Prior authorization and coding — reference procedure codes and NJ benefit rules
When submitting claims for cord blood harvesting and storage, include the applicable CPT/HCPCS procedure codes and note that coverage is governed by state-specific policy and the member's benefit contract terms (New Jersey).
- Coverage governed by federal, state, or contractual requirements; in case of conflict, those requirements govern.
Step therapy — none specified
No step therapy requirements are specified in this policy for umbilical cord blood harvesting or storage.
Coding documentation — include specific procedure codes
Include the listed procedure/billing codes for cord blood harvesting and cryopreservation on claims submissions to identify the services rendered.
- 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
- 88240 — Cryopreservation, freezing and storage of cells, each cell line
- S2140 — Cord blood harvesting for transplantation, allogeneic
Denial risk — prophylactic collection/storage for healthy individuals
Prophylactic collection and storage of umbilical cord blood for a currently healthy individual is considered unproven and not medically necessary and may be denied.
- Denial risk applies when the collection/storage is for a healthy individual seeking future unspecified autologous or allogeneic transplant.
Background
Umbilical cord and placental blood contain hematopoietic stem cells that can be used to treat hematologic malignancies, certain immunologic disorders, aplastic anemia, and some metabolic conditions. Cord blood banking salvages and cryogenically preserves these cells at birth for potential future autologous or allogeneic transplantation.
Public cord blood banks make units available for any matched recipient, while private banks store units for the donor or family; however, routine private storage for otherwise healthy newborns is not supported by current evidence and professional society guidance.
Definitions
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