Find policies, billing codes, payers, states, and providers
Umbilical Cord Blood Harvesting and Storage for Future Use (for Ohio Only)
Customize your policy alerts
Sign up for UnitedHealthcare Policy CS127OH.D alerts
Get alerted when Policy CS127OH.D changes without checking for updates manually.
Monitor payer policy activity
Ohio-specific UnitedHealthcare Community Plan policy governing coverage stance for prophylactic collection and storage of umbilical cord blood for future unspecified autologous or allogeneic transplantation; applies to requests evaluated under Ohio Administrative Code where relevant.
Supporting Information Updated FDA and References sections to reflect the most current information; previous policy version CS127OH.C archived.
Coverage Criteria
Not medically necessary - prophylactic storage
Covered when ALL of the following are met
Refer to the Optum Clinical Guideline titled 'Hematopoietic Stem Cell Transplantation' for coverage of actual transplant procedures.
UnitedHealthcare considers routine collection and private commercial banking of umbilical cord and placental blood for low-risk families to be not recommended. Professional society guidance encourages public donation when feasible and advises that directed (family) banking is appropriate when there is a known affected sibling or other family member with a disease likely to benefit from an allogeneic transplant. Providers should use these recommendations when counseling families about banking options and when evaluating coverage requests under Ohio requirements.
The available clinical evidence is insufficient to show benefit for prophylactic collection and storage of cord blood for a currently healthy individual who is storing for an unspecified future autologous or allogeneic transplant. Therefore, such prophylactic collection and storage are considered unproven and not medically necessary, and requests for private banking solely for unspecified future use may be denied.
Applicable Procedure and HCPCS 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 and Billing Notes
Codes are reference-only; coverage determined by law/contract
The listed procedure and HCPCS codes (38205, 38206, 38207, 88240, S2140) are provided for reference only; inclusion of a code in this policy does not imply the service is covered or payable. Benefit coverage is determined by applicable federal, state (Ohio), or contractual requirements and applicable laws, and the presence of a code does not guarantee reimbursement or prior authorization approval.
InterQual is primary; fallback to UHC criteria when InterQual lacks criteria
UnitedHealthcare uses InterQual® as the primary source for medical/surgical criteria. If InterQual does not have applicable criteria for the requested service, UnitedHealthcare may use its medical policies, Coverage Determination Guidelines, and/or Utilization Review Guidelines approved by the Ohio Department for Medicaid Services.
- InterQual® is primary for medical/surgical criteria
- Fallback: UnitedHealthcare policies/coverage determination/utilization review guidelines approved by Ohio Medicaid
Document decision framework: follow federal/state/contract rules and InterQual
When determining coverage, reference and follow federal, state (Ohio Administrative Code), and contractual benefit requirements; in the event of a conflict, those federal/state/contractual requirements govern. Use InterQual for primary criteria when applicable and consult UnitedHealthcare policies or Ohio‑approved guidelines when InterQual lacks criteria.
- Reference federal, state (OAC 5160-101) and contractual requirements when evaluating services
- If conflict exists, federal/state/contractual requirements prevail
- Use InterQual for primary decision framework; use UHC/OH‑approved guidelines as needed
Denial risk: prophylactic storage for healthy individuals is not covered
Requests for prophylactic collection and storage of umbilical cord blood for a currently healthy individual for unspecified future autologous or allogeneic transplant are considered unproven and not medically necessary and may be denied. Evaluations for services stated as unproven will be assessed using Ohio Administrative Code 5160-101.
- Prophylactic collection/storage for currently healthy individuals for unspecified future use is unproven and not medically necessary
- Such requests may be denied and will be evaluated under Ohio Administrative Code 5160-101
Background
Umbilical cord and placental blood contain hematopoietic stem cells that can be used to treat hematologic malignancies and certain immunologic and metabolic disorders; cord blood units have been used for both autologous and allogeneic transplantation. Cord blood banking involves salvaging and cryopreserving cord and placental blood immediately after birth so the unit is available for potential future transplant by the child or by family members, while public banks make units available for unrelated recipients. However, high-quality studies supporting prophylactic storage for unspecified future use are lacking, and professional societies recommend public donation and selective family-directed banking when a known affected relative exists.
Definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.