CurrentUnitedHealthcarePolicy CS127PA.O

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

UnitedHealthcare policy governing coverage of prophylactic collection and private storage of umbilical cord blood for future unspecified use, applicable only to members in Pennsylvania.

Policy Summary

PayerUnitedHealthcare

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

Policy CodePolicy CS127PA.O

Change TypeRevised coverage rationale and references

Effective DateOct 1, 2025

Next Review Date

Key ActionDocument medical necessity and reference applicable federal, state, or contractual requirements when submitting claims for cord blood collection or storage.

SourceLink

POLICY UPDATE CHANGES

Replaced language to specify that prophylactic collection and storage of umbilical cord blood 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 due to insufficient evidence of efficacy.

Pennsylvaniajurisdiction

Not medically necessarystance

4 CPTsreference codes

10/01/2025updated

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Coverage Criteria

Not medically necessary — prophylactic private cord blood storage

Not medically necessary — coverage stance

Primary coverage rule: Prophylactic collection and storage of umbilical cord blood 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 due to insufficient evidence of efficacy.

Refer to the Hematopoietic Stem Cell Transplantation clinical guideline for coverage of transplant procedures.

Routine private storage of umbilical cord blood for low-risk families is not recommended. Professional guidance emphasizes public banking where feasible and reserves directed or family banking for specific clinical situations rather than routine prophylactic use.

Directed or family cord blood banking is considered appropriate when there is a known sibling with a disease that may be successfully treated with an allogeneic hematopoietic stem cell transplant or when a family predisposition exists that makes cord blood therapeutically indicated. When these clinical circumstances exist, collection and storage are supported as a targeted, directed approach rather than general private banking for low-risk families.

Prophylactic collection and storage of umbilical cord blood for a currently healthy individual who desires to preserve tissue for a future unspecified autologous or allogeneic transplant is considered not medically necessary due to insufficient evidence of efficacy. Coverage for such prophylactic private banking may be denied.

Candidates for Directed/Family Banking

Directed/Family banking criteria

Directed/family cord blood banking is supported in specific circumstances as outlined below.

Directed/family banking indications: 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 or when a family predisposition to a condition treatable with cord blood exists.

ASTCT/ASBMT and ACOG recommend directed banking in these situations and discourage routine private storage for low-risk families.

Additional directed-banking consideration: Family member banking on behalf of a parent with a disease that may be successfully treated with an allogeneic transplant is recommended only when there are shared HLA antigens between the parents.

ASTCT/ASBMT guidance (Ballen et al, 2008).

Coding References

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 and Billing

Prior Authorization

Code listing and coverage determination

Applicable procedure codes for harvesting and cryopreservation are listed for reference; inclusion of a code does not imply coverage and benefit determination depends on 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.

Step Therapy

Step therapy

This policy specifies that no step therapy requirements apply to prophylactic cord blood collection or storage.

Background

Umbilical cord and placental blood contain hematopoietic stem cells that can be used to treat a range of hematologic, immunologic, and metabolic disorders. Collection and cryogenic storage of cord blood at birth (cord blood banking) preserves these cells for potential future autologous or allogeneic transplantation.

Public cord blood banks accept donations for general use, while private (family) banks store units for a specific individual or family. Professional societies recommend public banking where possible and limit personal storage to situations with a clear clinical indication (for example, a sibling with a disorder potentially treatable with an allogeneic transplant). For guidance on coverage of cord blood transplantation procedures, refer to the Hematopoietic Stem Cell Transplantation clinical guideline.

Definitions

Cord blood banking (definition)

DefinitionCord blood banking: process of salvaging umbilical cord and placental blood and cryogenically freezing it immediately after birth for potential future transplantation.

PurposeStore hematopoietic stem cell–rich cord/placental blood for possible future autologous (child) or allogeneic (family) transplant use.

Types of banksPrivate banks store for individual/family use; public banks accept donations for general use.

TimingCollection and cryogenic storage occur immediately after the birthing process.

Regulatory status (FDA)

Regulatory designationCord blood intended for use by a patient unrelated to the donor is defined as a 'drug' under the Food, Drug & Cosmetic Act and a 'biological product' under Section 351 of the Public Health Service Act.

Contraindications

Autologous cord blood use may be contraindicated when the donor later develops a hematologic malignancy such as leukemia or when the condition to be treated is inherent to the donor's own cells. In such situations, stored autologous cord blood would not be a safe or effective source of stem cells for transplantation and alternative allogeneic sources should be considered.

Evaluation Requirements

Documentation Required

Evaluation requirements — see transplant guideline

Refer to the Optum Clinical Guideline titled Hematopoietic Stem Cell Transplantation for evaluation and coverage requirements for cord blood transplantation procedures.

Center Requirements

Note

Center requirements — guideline referenced; no specific requirements stated

This policy references the Transplant Review Guidelines: Hematopoietic Stem Cell Transplantation; it does not specify any additional center accreditation, volume, or other center-specific requirements.

Post-Transplant Coverage

HSCT services

Coverage ruleCoverage for hematopoietic stem cell transplantation and related services should follow the Transplant Review Guidelines: Hematopoietic Stem Cell Transplantation and applicable benefit terms.

Reference guidelineSee Transplant Review Guidelines: Hematopoietic Stem Cell Transplantation (UnitedHealthcare) for evaluation and coverage details.

Benefit applicabilityFederal, state, or contractual benefit terms govern coverage decisions when they differ from the standard policy guidance.