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Umbilical Cord Blood Harvesting and Storage for Future Use (for Idaho Only)
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Policy governs coverage for prophylactic collection and private storage of umbilical cord blood for future, unspecified use and applies only to members in the state of Idaho, including Idaho Medicaid Plus plans.
Supporting Information Updated FDA and References sections to reflect the most current information.
Coverage Criteria — Umbilical Cord Blood Banking
Prophylactic/private cord blood banking (Not medically necessary)
Not covered when the following condition applies:
Refer to the Optum Clinical Guideline: Hematopoietic Stem Cell Transplantation for transplant coverage and indications.
Routine private collection and long-term storage of umbilical cord blood for otherwise healthy, low-risk families is not recommended. Major specialty organizations encourage public banking where possible and support directed/family banking only when there is a known affected sibling or other family member with a condition potentially treatable with allogeneic transplant. Refer to specialty guidance for transplant coverage decisions.
Prophylactic or autologous storage of cord blood for an otherwise healthy individual is considered not medically necessary because evidence does not demonstrate benefit for routine, unspecified future use. Professional societies (AAP, ACOG) note limited evidence supporting autologous banking for later self-use and advise that autologous units may be contraindicated if the donor later develops certain diseases (for example, leukemia). Families should be counseled about the low likelihood of autologous use and the lack of evidence for routine prophylactic storage.
Covered Indications and Regimens
| Regimen | Indication | Coverage status |
|---|---|---|
| Cord blood transplantation (public or directed allogeneic) | ||
| Use of cord blood as a source of hematopoietic stem cells for transplant procedures for indicated hematologic disorders (e.g., leukemia, lymphoma, myeloma, aplastic anemia, certain immunologic/metabolic disorders) | ||
| Informational |
Applicable Procedure and Billing Codes
| 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 |
Provider Actions, Billing Notes, and Risk
Prior authorization / coding reference
Coverage for harvesting and storage procedures is determined by the member's plan benefits; the policy provides the following CPT/HCPCS codes for reference only: 38205, 38206, 38207, 88240, and S2140. Inclusion of these codes does not imply coverage or guarantee reimbursement; benefit determination is subject to federal, state, or contractual requirements.
- 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
No step therapy required by this policy
This policy does not specify any step therapy requirements for cord blood harvesting or storage.
Coding and claim submission note
When submitting claims, providers may reference procedure codes such as 38205, 38206, 38207, 88240 and HCPCS S2140; listing is for reference only and does not guarantee coverage or payment.
- Listing of a code in this policy does not imply that the service described by the code is a covered or non-covered health service.
- Benefit coverage is determined by federal, state, or contractual requirements and applicable laws.
Denial risk — prophylactic/private cord blood banking
Prophylactic collection and storage of umbilical cord blood for an individual who is currently healthy is considered unproven and not medically necessary and may be denied.
- Policy states prophylactic collection and storage is unproven and not medically necessary for otherwise healthy individuals desiring future unspecified autologous or allogeneic transplant.
Definitions
Background and Evidence Summary
Umbilical cord and placental blood contain hematopoietic stem cells that can be used as a source for hematopoietic stem cell transplantation to treat certain hematologic malignancies, aplastic anemia, and selected immunologic or metabolic disorders. Cord blood units may be stored for future autologous use or for allogeneic transplant (directed family use or public donation); public banks make units broadly available while private banks store units for potential directed use by the child or family members.
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