AuSCT is a process used to treat various malignancies in which stem cells are harvested from a patient's bone marrow or peripheral blood, stored, and then given back to the patient following severely myelotoxic doses of chemotherapy and/or radiotherapy. Section 35-30.1 of the Coverage Issues Manual (CIM) states that AuSCT is a non-covered condition in the treatment for multiple myeloma (MM). This decision was based on the insufficiency of data to establish efficacy. The Health Care Financing Administration (HCFA) must evaluate whether new scientific data on AuSCT supports reconsideration for national coverage in the MM population.
In instances where HCFA issues a decision and payment changes need to be made to implement the policy, claims processing instructions must be written and officially transmitted to our Medicare contractors in order to allow for proper billing and payment of claims for this procedure. According to our coverage process, HCFA has up to 180 days from the next full calendar quarter (which starts on July 1, 2000) to implement any payment changes. Once instructions have been released to the contractors, HCFA will post the effective date of this revised policy. Services provided to beneficiaries on or after that date would be eligible for payment. HCFA will be unable to retroactively reimburse claims prior to the anticipated implementation date.