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Umbilical Cord Blood Harvesting and Storage for Future Use (for Indiana Only)
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Policy governing coverage stance for prophylactic collection and private storage of umbilical cord blood for future unspecified autologous or allogeneic use; applies only to UnitedHealthcare Community Plan members in Indiana.
Supporting Information Updated FDA and References sections to reflect the most current information; previous policy version CS127IN.04 archived.
Coverage Criteria
Routine prophylactic/private cord blood storage
Covered stance
Refer to the Optum Clinical Guideline titled Hematopoietic Stem Cell Transplantation for coverage of transplant procedures.
When there is a known sibling with a disease potentially treatable with an allogeneic hematopoietic stem cell transplant, directed family banking is recommended. Specialty society guidance encourages collection and storage of cord blood to provide a potential allogeneic donor source for that affected sibling, and family-directed banking may be considered when a familial predisposition indicates likely future need. Providers should refer to ASTCT/ASBMT and ACOG recommendations when counseling families and documenting the clinical rationale for directed banking.
Storage of umbilical cord blood for hypothetical or unspecified future use lacks high-quality supporting evidence and is considered unproven. Consequently, prophylactic private banking for an otherwise healthy individual who seeks to store cord blood as a form of insurance for an unspecified future autologous or allogeneic transplant is not medically necessary. This position is based on the absence of robust clinical studies demonstrating benefit and is consistent with guidance from major specialty organizations advising that routine private banking is not supported by the evidence.
Coding
| 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
Prior authorization and managed codes (Indiana) — see PA list
Codes listed below are those the plan references for cord blood harvesting, cryopreservation, and storage. Codes marked with an asterisk (*) were not managed for medical necessity review for the State of Indiana at the policy effective date; providers must consult the UnitedHealthcare Community Plan of Indiana prior authorization and notification list for current 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
Provider billing and authorization actions
Submit prior authorization or notification per the UnitedHealthcare Community Plan of Indiana requirements when applicable; check the Indiana prior authorization list for current operational instructions.
- Refer to the UnitedHealthcare Community Plan of Indiana Prior Authorization and Notification list for which codes require prior authorization or notification.
- Codes with an asterisk are not managed for medical necessity review for Indiana at the policy effective date and may not require medical necessity review locally — verify current status on the PA list.
CPT / HCPCS codes for reference and documentation
Reference the specific CPT and HCPCS codes below when documenting services related to cord blood collection, cryopreservation, and storage; note asterisks indicate codes not managed for medical necessity review in Indiana at policy effective date.
Do not pursue prophylactic storage for healthy individuals — potential denial
Do not bill for or expect coverage of routine prophylactic collection and storage of umbilical cord blood for otherwise healthy individuals seeking unspecified future autologous or allogeneic use; such services are considered not medically necessary and may be denied.
- Policy states prophylactic collection and storage for a currently healthy individual desiring future unspecified transplant is unproven and not medically necessary.
- For coverage of actual transplant procedures, refer to the Hematopoietic Stem Cell Transplantation guideline.
Definitions
Background
Umbilical cord and placental blood are rich sources of hematopoietic stem cells that can be used to treat hematologic malignancies, bone marrow failure syndromes, and certain immunologic and metabolic disorders. Cord blood may be stored in private banks for potential autologous or family-directed (allogeneic) use, or donated to public banks to increase availability for unrelated recipients. Evidence is insufficient to support routine prophylactic private banking for low-risk individuals, but cord blood remains an important therapeutic source when transplantation is clinically indicated.
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