CurrentUnitedHealthcarePolicy CS127OH.C

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

Policy governing prophylactic collection and private storage of umbilical cord blood for potential future autologous or allogeneic transplantation for UnitedHealthcare members in Ohio.

Policy Summary

PayerUnitedHealthcare

PolicyUmbilical Cord Blood Harvesting and Storage for Future Use (for Ohio Only)

Policy CodePolicy CS127OH.C

Change TypeRevised languageupdated references

Effective DateOct 1, 2025

Next Review Date

Key ActionCheck federal, state (Ohio Administrative Code), or contractual requirements when deciding coverage; UnitedHealthcare may use InterQual and other guidelines for utilization review.

SourceLink

POLICY UPDATE CHANGES

Replaced language describing collection and storage as unproven and not medically necessary for a person who is currently healthy and desiring to provide opportunity for a hypothetical future transplantation with language specifying 'prophylactic collection and storage ... is unproven and not medically necessary for an individual who is currently healthy but desiring to provide the opportunity for a future unspecified autologous or allogeneic stem cell transplantation'.

Updated supporting information in Clinical Evidence and References sections to reflect current information.

OHstate

CS127OH.Cpolicy id

Oct 1, 2025effective

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coverage Criteria

Not medically necessary — prophylactic private cord blood banking

Primary coverage decision: Prophylactic collection and storage of umbilical cord blood for an individual who is currently healthy and desiring to provide the opportunity for a future unspecified autologous or allogeneic stem cell transplantation is unproven and not medically necessary due to insufficient evidence of efficacy.

Refer to the UnitedHealth Group Transplant Review Guidelines: Hematopoietic Stem Cell Transplantation for coverage of actual hematopoietic stem cell transplantation.

Directed cord blood banking may be appropriate when there is a known affected sibling who could benefit from an allogeneic hematopoietic stem cell transplantation. Professional society guidance states: collecting and storing cord blood for a family member is recommended when there is a sibling with a disease that may be successfully treated with an allogeneic transplant. Providers should document the clinical indication and relationship to the affected sibling to support directed banking decisions and follow applicable state or contractual requirements for coverage and utilization review.

Prophylactic collection and private storage of umbilical cord blood for an otherwise healthy individual who desires to preserve cells for a future unspecified autologous or allogeneic transplant is considered unproven and not medically necessary due to insufficient evidence of efficacy. Such requests may be denied under this policy; for coverage of actual hematopoietic stem cell transplantation, refer to the UnitedHealth Group Transplant Review Guidelines.

Coding

Applicable procedure codes (reference only)CPT

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

Provider Actions

Documentation Required

Coding reference and documentation note

The following codes are provided for reference only. Listing of a code in this policy does not guarantee coverage or payment. Providers must reference the member’s plan, federal/state/contractual requirements, and supply adequate documentation to support medical necessity when submitting claims.

Codes listed are for reference and do not ensure coverage or reimbursement.
Ensure documentation supports medical necessity and ties to covered indication.

Step Therapy

No step therapy requirements specified

No step therapy requirements for this service are specified in this policy. Verify any plan-specific utilization management rules or contract requirements prior to providing services.

If InterQual or other utilization criteria are applied by UnitedHealthcare, follow those criteria for coverage determinations.

Background

Umbilical cord and placental blood contain a rich source of hematopoietic stem cells that can be used to treat certain malignant, non-malignant hematologic, and immunologic disorders. Cord blood banking involves salvaging and cryogenically storing these cells for potential future autologous or allogeneic transplantation; public banks accept donated units for general use while private banks store units for the donor or family.

Definitions

Private vs Public cord blood banking — key distinctions

Private bank purposeStores cord blood for future use by the child (autologous) or family members (allogeneic).

Public bank purposeAccepts donated cord blood and makes units available to any compatible recipient in need.

Use caseSalvaged umbilical cord and placental blood are cryogenically stored as a source of hematopoietic stem cells for future transplant procedures (e.g., leukemia, lymphoma, aplastic anemia).

Evaluation Requirements

Note

Follow Transplant Review Guidelines for evaluation and approval

Evaluation and coverage decisions for hematopoietic stem cell transplantation should follow the UnitedHealth Group Transplant Review Guidelines and applicable federal, state (OAC), or contractual requirements.

Refer to: UnitedHealth Group Transplant Review Guidelines: Hematopoietic Stem Cell Transplantation

Center Requirements

Documentation Required

Refer to Transplant Review Guidelines for center requirements

Refer to the UnitedHealth Group Transplant Review Guidelines for transplant center and evaluation requirements when arranging hematopoietic stem cell transplantation services.

Post-Transplant Coverage

Hematopoietic stem cell transplantation — related guidance

Coverage referralCoverage related to hematopoietic stem cell transplantation is addressed in the UnitedHealth Group Transplant Review Guidelines: Hematopoietic Stem Cell Transplantation.

Evaluation and eligibilityEvaluation and coverage for hematopoietic stem cell transplantation should follow the Transplant Review Guidelines and applicable federal/state/contractual requirements.

Center requirementsRefer to the UnitedHealth Group Transplant Review Guidelines for transplant center and evaluation requirements for HSCT.

Utilization toolsUnitedHealthcare may apply InterQual criteria (and other approved guidelines) in utilization review for transplant services.