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    v1.0.30
    OpenPayerPolicy UpdatesTransplantUnitedHealthcare Cord Blood Coverage | OpenPayer
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    CurrentUnitedHealthcarePolicy CS127PA.P

    Umbilical Cord Blood Harvesting and Storage for Future Use (for Pennsylvania Only)

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    This policy governs coverage of prophylactic umbilical cord and placental blood collection and storage for potential future autologous or allogeneic stem cell transplantation. It applies only to UnitedHealthcare Community Plan members and services in Pennsylvania.

    Policy Summary
    PayerUnitedHealthcare
    PolicyUmbilical Cord Blood Harvesting and Storage for Future Use
    Policy CodePolicy CS127PA.P
    Change TypeAdministrative and informational updateno material coverage changes
    Effective DateSeptember 1, 2026
    Next Review DateNot specified
    Key ActionDo not consider prophylactic umbilical cord blood collection and storage medically necessary for a currently healthy individual seeking unspecified future transplant use.
    SourceLink
    POLICY UPDATE CHANGES

    The policy history documents updates to the Pennsylvania Code reference, FDA information, and references.

    The application section was updated to reference Pennsylvania Code § 55.1101.31(f) exceptions.

    PA onlyGeographic application
    Not coveredProphylactic collection and storage
    4 CPTListed procedure codes

    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.

    Case-by-caseExceptions

    Coverage Criteria

    Prophylactic collection and storage for hypothetical future use

    Prophylactic collection and storage of umbilical cord blood for hypothetical future use is not medically necessary when ALL of the following apply:

    ALL of the following

    • The umbilical cord blood is being collected and stored prophylactically.
    • The individual is currently healthy.
    • The collection and storage are intended to provide the opportunity for a future unspecified autologous or allogeneic stem cell transplantation.

    Due to insufficient evidence of efficacy, prophylactic collection and storage of umbilical cord blood is unproven and not medically necessary for an individual who is currently healthy but desires to provide the opportunity for a future unspecified autologous or allogeneic stem cell transplantation.

    Coding

    CPT CodesCPT
    38205Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; allogeneic.
    38206Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; autologous.
    38207Transplant preparation of hematopoietic progenitor cells; cryopreservation and storage.
    88240Cryopreservation, freezing and storage of cells, each cell line
    Additional Applicable CodeHCPCS
    S2140Cord blood harvesting for transplantation, allogeneic

    Provider Actions

    Denial Risk

    Risk of denial for hypothetical future use

    Do not pursue coverage for prophylactic collection and storage of umbilical cord blood when the individual is currently healthy and seeks the opportunity for an unspecified future autologous or allogeneic stem cell transplantation. UnitedHealthcare considers this use unproven and not medically necessary due to insufficient evidence of efficacy.

    Background

    Umbilical cord and placental blood contain hematopoietic stem cells that may be used for transplantation in conditions such as leukemia, lymphoma, myeloma, aplastic anemia, and certain immunologic or metabolic disorders. Cord blood banking involves collecting and cryogenically storing this blood after birth for possible future use by the child, a family member, or through donation to a public bank. The policy states that high-quality evidence does not establish efficacy when storage is intended for hypothetical future use.

    Definitions

    Autologous
    DefinitionCord blood collected and stored for possible use by the child from whom it was collected.
    Allogeneic
    DefinitionCord blood collected for possible use by another person, such as a family member.
    Cord blood banking
    DefinitionCollection and cryogenic storage of umbilical cord and placental blood for potential future transplant procedures.
    Policy Summary
    PayerUnitedHealthcare
    PolicyUmbilical Cord Blood Harvesting and Storage for Future Use
    Policy CodePolicy CS127PA.P
    Change TypeAdministrative and informational updateno material coverage changes
    Effective DateSeptember 1, 2026
    Next Review DateNot specified
    Key ActionDo not consider prophylactic umbilical cord blood collection and storage medically necessary for a currently healthy individual seeking unspecified future transplant use.
    SourceLink
    On This Page
    Coverage CriteriaCodingProvider ActionsBackgroundDefinitions