Effective for claims with service dates on or after Aug. 4, Medicare will nationally cover the use of allogenic hematopoietic stem cell transplantation (HSCT) for myelodysplastic syndrome (MDS) when provided in a Medicare-approved clinical study under Coverage Evidence Development (CED). In all other settings, HSCT for MDS is nationally non-covered by Medicare.

MDS refers to a group of diverse blood disorders in which the bone marrow does not produce enough healthy, functioning blood cells. For more information about this disorder, see Pub. 100-03, National Coverage Determination Manual, chapter 1, sec. 110.8.1.

Medicare contractors will reimburse professional and outpatient (place of service codes 21 and 22) HSCT for MDS claims coded as such:

  • ICD-9-CM diagnosis code V70.7 Examination of participant in clinical trial
  • CPT® code 38240 Bone marrow or blood-derived peripheral stem cell transplantation; allogenic
  • Modifier Q0 Investigational clinical service provided in an approved clinical research study
  • Eight-digit clinical trial number, if provided

See Pub. 100-04, chapter 32, sec. 90.6 and chapter 3, sec. 90.3.1 of the Claims Processing Manual for further Medicare coding and billing information.

Source: The Centers for Medicare & Medicaid Services (CMS), Oct. 8, Transmittal 2062, Change Request (CR) 7137 and Transmittal 127, CR 7137.


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