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Billing and Coding: Stem Cell Transplantation

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Article ID
A52879
Article Title
Billing and Coding: Stem Cell Transplantation
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
04/01/2022
Revision Ending Date
09/30/2022
Retirement Date
N/A
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CMS National Coverage Policy

N/A

Article Guidance

Article Text

Abstract:

Stem cell transplantation is a process in which stem cells are harvested from either a patient's (autologous) or donor's allogenic bone marrow or peripheral blood for intravenous infusion. (AuSCT) is a technique for restoring stem cells using the patient's own previously stored cells. (AuSCT) must be used to effect hematopoietic reconstitution following severely myelotoxic doses of chemotherapy (HDCT) and/or radiotherapy used to treat various malignancies. Allogeneic stem cell transplantation (HSCT) is a procedure in which a portion of a healthy donor's stem cell or bone marrow is obtained and prepared for intravenous infusion. Allogeneic HSCT may also be used to restore function in recipients having an inherited or acquired deficiency or defect. Hematopoietic stem cells are multi-potent stem cells that give rise to all the blood cell types; these stem cells form blood and immune cells. A hematopoietic stem cell is a cell isolated from blood or bone marrow that can renew itself, differentiate to a variety of specialized cells, can mobilize out of the bone marrow into circulating blood, and can undergo programmed cell death, called apoptosis - a process by which cells that are unneeded or detrimental self destruct. (CMS Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 2: Section 110.23).

...bone marrow and peripheral blood stem cell transplantation is a process which includes mobilization, harvesting, and transplant of bone marrow or peripheral blood stem cells and the administration of high dose chemotherapy or radiotherapy prior to the actual transplant. When bone marrow or peripheral blood stem cell transplantation is covered, all necessary steps are included in coverage. When bone marrow or peripheral blood stem cell transplantation is non-covered, none of the steps are covered. (CMS Publication 100-03, Medicare National Coverage Determinations(NCD) Manual, Chapter 1, Part 2: Section 110.23).

The CMS National Coverage Determination (NCD) for Stem Cell Transplantation describes nationally covered indications for stem cell transplant, the details of which will not be repeated here. This Medical policy article describes additional locally covered indications for stem cell transplant.

Indications and Limitations:

Hematopoietic Progenitor Cell (HPC);Allogeneic Transplantation
The ICD-10-PCS Procedure codes are: 30233G2, 30233G3, 30233Y2, 30233Y3, 30243G2, 30243G3, 30243Y2 and 30243Y3.

The NCD lists the following nationally covered indications:

  • Leukemia;
  • Leukemia in remission;
  • Aplastic anemia;
  • Severe combined immunodeficiency disease (SCID); and
  • Wiskott-Aldrich syndrome.
  • Effective for services performed on or after August 4, 2010, for the treatment of Myelodysplastic Syndromes (MDS) pursuant to Coverage with Evidence Development (CED) in the context of a Medicare-approved, prospective clinical study. (Please refer to CMS Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 2: Section 110.23).

Allogeneic HSCT is covered only for Medicare beneficiaries with the following indications when participating in an approved prospective clinical study meeting specific criteria under the CED paradigm:

  • Multiple myeloma only for beneficiaries with Durie-Salmon Stage II or III multiple myeloma, or International Staging System (ISS) Stage II or Stage III multiple myeloma;
  • Myelofibrosis (MF) only for beneficiaries with Dynamic International Prognostic Scoring System (DIPSSplus) intermediate-2 or High primary or secondary MF or
  • Sickle cell disease (SCD) only for beneficiaries with severe, symptomatic SCD who participate in an approved prospective clinical study meeting specific criteria under the CED paradigm. (Please refer to CMS Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 2: Section 110.23).

In addition to the nationally covered indications for HPC, allogenic, the following indications will be covered locally, for those jurisdictions or providers for whom this Medical Policy article applies, when medically necessary:

  • Primary refractory Hodgkin's and non-Hodgkin's lymphoma; and
  • Thalassemia major for patients with minimal or no portal fibrosis, hepatomegaly, or active hepatitis.

Hematopoietic Progenitor Cell (HPC);Autologous Transplantation
(ICD-10-PCS Procedure codes 30233C0, 30233G0, 30243C0, 30243G0, 30233Y0, and 30243Y0)

The NCD lists the following nationally covered indications:

  • Acute leukemia in remission in patients who have a high probability of relapse and who have no human leucocyte antigens (HLA)-matched donor;
  • Resistant non-Hodgkin's lymphomas or those presenting with poor prognostic features following an initial response;
  • Recurrent or refractory neuroblastoma;
  • Advanced Hodgkin's disease who have failed conventional therapy and have no HLA-matched donor;
  • Single HPC, autologous is only covered for Durie-Salmon Stage II or III patients that fit the following requirements:
    • Newly diagnosed or responsive multiple myeloma. This includes those patients with previously untreated disease, those with at least a partial response to prior chemotherapy (defined as a 50% decrease either in measurable paraprotein [serum and/or urine] or in bone marrow infiltration, sustained for at least 1 month), and those in responsive relapse; and
    • Adequate cardiac, renal, pulmonary, and hepatic function.
  • HPC, autologous in combination with high dose melphalan for patients with primary amyloid light chain amyloidosis, with amyloid deposition in two or fewer organs and a cardiac left ventricular ejection fraction greater than 45%.

In addition to the nationally covered indications for HPC, autologous, the following indication will be covered locally, for those jurisdictions or providers for whom this Medical Policy article applies, when medically necessary:

  • Anaplastic large cell lymphoma
  • Large cell lymphoma/B-cell lymphoma
  • Peripheral T-cell lymphoma
  • Primary central nervous system lymphoma
  • Testicular cancer
  • Waldenström macroglobulinemia

The NCD lists the following nationally non-covered indications:

    • Acute leukemia not in remission;
    • Chronic granulocytic leukemia;
    • Solid tumors (other than neuroblastoma); and
    • Tandem transplantation (multiple rounds of HPC, autologous) for patients with multiple myeloma

Coding Information 

Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare

For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim

A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act

The diagnosis code(s) must best describe the patient's condition for which the service was performed.

Advance Beneficiary Notice of Noncoverage (ABN) Modifier Guideline

An ABN may be used for services which are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30, for complete instructions.

Specific coding guidelines for this Medical Policy article

Per CMS Transmittal No. 193, Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, and Transmittal No. 3556, Publication 100-4, Medicare Claims Processing Manual, Change Request #9620, July 1, 2016 the following coding guidelines are specified for Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) for Myelodysplastic Syndrome (MDS), multiple myeloma, myelofibrosis (MF) and sickle cell disease (SCD):

For the treatment of Myelodysplastic Syndromes (MDS) ICD-10-CM codes D46.A, D46.B, D46.C, D46.0, D46.1, D46.20, D46.21,D46.22, D46.4, D46.9, D46.Z) pursuant to Coverage with Evidence Development (CED) in the context of a Medicare-approved, prospective clinical study. Refer to Pub. 100-03, NCD Manual, chapter 1, section 110.23, for further information about this policy.

Effective for services performed on or after January 27, 2016:

  • Allogeneic HSCT for multiple myeloma (ICD-10-CM codes C90.00, C90.01, and C90.02) is covered by Medicare only for beneficiaries with Durie-Salmon Stage II or III multiple myeloma, or International Staging System (ISS) Stage II or Stage III multiple myeloma, and participating in an approved prospective clinical study. Refer to Pub. 100-03, NCD Manual, chapter 1, section 110.23, for further information about this policy.
  • Allogeneic HSCT for myelofibrosis (MF) (ICD-10-CM codes C94.40, C94.41, C94.42, D47.4, and D75.81) is covered by Medicare only for beneficiaries with Dynamic International Prognostic Scoring System (DIPSSplus) intermediate-2 or High primary or secondary MF and participating in an approved prospective clinical study. Refer to Pub. 100-03, NCD Manual, chapter 1, section 110.23, for further information about this policy.
  • Allogeneic HSCT for sickle cell disease (SCD) (ICD-10-CM codes D57.00, D57.01, D57.02, D57.03, D57.09, D57.1, D57.20, D57.211, D57.212, D57.213, D57.218, D57.219, D57.40, D57.411, D57.412, D57.413, D57.418, D57.419, D57.42, D57.431, D57.432, D57.433, D57.438, D57.439, D57.44, D57.451, D57.452, D57.453, D57.458, D57.459, D57.80, D57.811, D57.812, D57.813, D57.818, and D57.819) is covered by Medicare only for beneficiaries with severe, symptomatic SCD who participate in an approved prospective clinical study. Refer to Pub. 100-03, NCD Manual, chapter 1, section 110.23, for further information about this policy.

For claims submitted to the Part B MAC:

All services/procedures performed on the same day for the same beneficiary by the physician/provider should be billed on the same claim.

For claims submitted to the Part A MAC:

Hospital Inpatient Claims:

  • The hospital should report the patient's principal diagnosis in Form Locator (FL) 67 of the UB-04. The principal diagnosis is the condition established after study to be chiefly responsible for this admission.
  • The hospital enters ICD-10-CM codes for up to eight additional conditions in FLs 67A-67Q if they co-existed at the time of admission or developed subsequently, and which had an effect upon the treatment or the length of stay. It may not duplicate the principal diagnosis listed in FL 67.
  • For inpatient hospital claims, the admitting diagnosis is required and should be recorded in FL 69. (See CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 25, Section 75 for additional instructions.)

Hospital Outpatient Claims:

  • The hospital should report the full ICD-10-CM code for the diagnosis shown to be chiefly responsible for the outpatient services in FL 67. If no definitive diagnosis is made during the outpatient evaluation, the patient's symptom is reported. If the patient arrives without a referring diagnosis, symptom or complaint, the provider should report an ICD-10-CM code for Persons Without Reported Diagnosis Encountered During Examination and Investigation of Individuals and Populations (Z00.00-Z13.9).
  • The hospital enters the full ICD-10-CM codes in FLs 67A-67Q for up to eight other diagnoses that co-existed in addition to the diagnosis reported in FL 67.

Sources of Information:

CMS National Coverage Policy

CMS Publications:

CMS Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 2:110.23 Stem Cell Transplantation

CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 3, Section 90.3.1 Stem Cell Transplantation.

CMS Transmittal No. 127, Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Change Request #7137, October 8, 2010 updates Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) for Myelodysplastic Syndrome (MDS) to allow Medicare coverage for treatment of MDS only if provided in the context of a Medicare-approved clinical study meeting specific criteria under the CED paradigm.

Decision Memo for Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) for Myelodysplastic Syndrome (CAG-00415N).

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Coding Information

CPT/HCPCS Codes

Expand All | Collapse All

Group 1

(2 Codes)
Group 1 Paragraph

N/A

 Group 1 Codes
CodeDescription
38240 HEMATOPOIETIC PROGENITOR CELL (HPC); ALLOGENEIC TRANSPLANTATION PER DONOR
38241 HEMATOPOIETIC PROGENITOR CELL (HPC); AUTOLOGOUS TRANSPLANTATION

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

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Group 1

(466 Codes)
Group 1 Paragraph

The correct use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination.

For allogeneic hematopoietic progenitor cell transplantation, CPT code 38240:

ICD-10-CM codes C90.00, C90.01, C90.02, C94.40, C94.41, C94.42, D46.0, D46.1, D46.20, D46.21, D46.22, D46.A, D46.B, D46.C, D46.4, D46.Z, D46.9, D47.1, D47.4, D57.00, D57.01, D57.02, D57.03, D57.09, D57.1, D57.20, D57.211, D57.212, D57.213, D57.218, D57.219, D57.40, D57.411, D57.412, D57.413, D57.418, D57.419, D57.42, D57.431, D57.432, D57.433, D57.438, D57.439, D57.44, D57.451, D57.452, D57.453, D57.458, D57.459, D57.80, D57.811, D57.812, D57.813, D57.818, D57.819, D75.81 and Z00.6 are only covered when meeting national coverage determination requirements for Coverage with Evidence Development (CED)

 Group 1 Codes
CodeDescription
C81.01 - C81.09 Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of head, face, and neck - Nodular lymphocyte predominant Hodgkin lymphoma, extranodal and solid organ sites
C81.11 - C81.19 Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, and neck - Nodular sclerosis Hodgkin lymphoma, extranodal and solid organ sites
C81.21 - C81.29 Mixed cellularity Hodgkin lymphoma, lymph nodes of head, face, and neck - Mixed cellularity Hodgkin lymphoma, extranodal and solid organ sites
C81.31 - C81.39 Lymphocyte depleted Hodgkin lymphoma, lymph nodes of head, face, and neck - Lymphocyte depleted Hodgkin lymphoma, extranodal and solid organ sites
C81.41 - C81.49 Lymphocyte-rich Hodgkin lymphoma, lymph nodes of head, face, and neck - Lymphocyte-rich Hodgkin lymphoma, extranodal and solid organ sites
C81.71 - C81.79 Other Hodgkin lymphoma, lymph nodes of head, face, and neck - Other Hodgkin lymphoma, extranodal and solid organ sites
C81.91 - C81.99 Hodgkin lymphoma, unspecified, lymph nodes of head, face, and neck - Hodgkin lymphoma, unspecified, extranodal and solid organ sites
C82.01 - C82.09 Follicular lymphoma grade I, lymph nodes of head, face, and neck - Follicular lymphoma grade I, extranodal and solid organ sites
C82.11 - C82.19 Follicular lymphoma grade II, lymph nodes of head, face, and neck - Follicular lymphoma grade II, extranodal and solid organ sites
C82.21 - C82.29 Follicular lymphoma grade III, unspecified, lymph nodes of head, face, and neck - Follicular lymphoma grade III, unspecified, extranodal and solid organ sites
C82.31 - C82.39 Follicular lymphoma grade IIIa, lymph nodes of head, face, and neck - Follicular lymphoma grade IIIa, extranodal and solid organ sites
C82.41 - C82.49 Follicular lymphoma grade IIIb, lymph nodes of head, face, and neck - Follicular lymphoma grade IIIb, extranodal and solid organ sites
C82.51 - C82.59 Diffuse follicle center lymphoma, lymph nodes of head, face, and neck - Diffuse follicle center lymphoma, extranodal and solid organ sites
C82.61 - C82.69 Cutaneous follicle center lymphoma, lymph nodes of head, face, and neck - Cutaneous follicle center lymphoma, extranodal and solid organ sites
C82.81 - C82.89 Other types of follicular lymphoma, lymph nodes of head, face, and neck - Other types of follicular lymphoma, extranodal and solid organ sites
C82.91 - C82.99 Follicular lymphoma, unspecified, lymph nodes of head, face, and neck - Follicular lymphoma, unspecified, extranodal and solid organ sites
C83.01 - C83.09 Small cell B-cell lymphoma, lymph nodes of head, face, and neck - Small cell B-cell lymphoma, extranodal and solid organ sites
C83.11 - C83.19 Mantle cell lymphoma, lymph nodes of head, face, and neck - Mantle cell lymphoma, extranodal and solid organ sites
C83.31 - C83.39 Diffuse large B-cell lymphoma, lymph nodes of head, face, and neck - Diffuse large B-cell lymphoma, extranodal and solid organ sites
C83.51 - C83.59 Lymphoblastic (diffuse) lymphoma, lymph nodes of head, face, and neck - Lymphoblastic (diffuse) lymphoma, extranodal and solid organ sites
C83.71 - C83.79 Burkitt lymphoma, lymph nodes of head, face, and neck - Burkitt lymphoma, extranodal and solid organ sites
C83.81 - C83.89 Other non-follicular lymphoma, lymph nodes of head, face, and neck - Other non-follicular lymphoma, extranodal and solid organ sites
C83.91 - C83.99 Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of head, face, and neck - Non-follicular (diffuse) lymphoma, unspecified, extranodal and solid organ sites
C84.41 - C84.49 Peripheral T-cell lymphoma, not classified, lymph nodes of head, face, and neck - Peripheral T-cell lymphoma, not classified, extranodal and solid organ sites
C84.A1 - C84.A9 Cutaneous T-cell lymphoma, unspecified lymph nodes of head, face, and neck - Cutaneous T-cell lymphoma, unspecified, extranodal and solid organ sites
C84.Z1 - C84.Z9 Other mature T/NK-cell lymphomas, lymph nodes of head, face, and neck - Other mature T/NK-cell lymphomas, extranodal and solid organ sites
C84.91 - C84.99 Mature T/NK-cell lymphomas, unspecified, lymph nodes of head, face, and neck - Mature T/NK-cell lymphomas, unspecified, extranodal and solid organ sites
C85.11 - C85.19 Unspecified B-cell lymphoma, lymph nodes of head, face, and neck - Unspecified B-cell lymphoma, extranodal and solid organ sites
C85.21 - C85.29 Mediastinal (thymic) large B-cell lymphoma, lymph nodes of head, face, and neck - Mediastinal (thymic) large B-cell lymphoma, extranodal and solid organ sites
C85.81 - C85.89 Other specified types of non-Hodgkin lymphoma, lymph nodes of head, face, and neck - Other specified types of non-Hodgkin lymphoma, extranodal and solid organ sites
C85.91 - C85.99 Non-Hodgkin lymphoma, unspecified, lymph nodes of head, face, and neck - Non-Hodgkin lymphoma, unspecified, extranodal and solid organ sites
C86.0 Extranodal NK/T-cell lymphoma, nasal type
C86.1 Hepatosplenic T-cell lymphoma
C86.2 Enteropathy-type (intestinal) T-cell lymphoma
C86.3 Subcutaneous panniculitis-like T-cell lymphoma
C86.4 Blastic NK-cell lymphoma
C86.5 Angioimmunoblastic T-cell lymphoma
C86.6 Primary cutaneous CD30-positive T-cell proliferations
C90.00 Multiple myeloma not having achieved remission
C90.01 Multiple myeloma in remission
C90.02 Multiple myeloma in relapse
C91.00 Acute lymphoblastic leukemia not having achieved remission
C91.01 Acute lymphoblastic leukemia, in remission
C91.02 Acute lymphoblastic leukemia, in relapse
C91.10 Chronic lymphocytic leukemia of B-cell type not having achieved remission
C91.11 Chronic lymphocytic leukemia of B-cell type in remission
C91.12 Chronic lymphocytic leukemia of B-cell type in relapse
C91.30 Prolymphocytic leukemia of B-cell type not having achieved remission
C91.31 Prolymphocytic leukemia of B-cell type, in remission
C91.32 Prolymphocytic leukemia of B-cell type, in relapse
C91.50 Adult T-cell lymphoma/leukemia (HTLV-1-associated) not having achieved remission
C91.51 Adult T-cell lymphoma/leukemia (HTLV-1-associated), in remission
C91.52 Adult T-cell lymphoma/leukemia (HTLV-1-associated), in relapse
C91.60 Prolymphocytic leukemia of T-cell type not having achieved remission
C91.61 Prolymphocytic leukemia of T-cell type, in remission
C91.62 Prolymphocytic leukemia of T-cell type, in relapse
C91.A0 Mature B-cell leukemia Burkitt-type not having achieved remission
C91.A1 Mature B-cell leukemia Burkitt-type, in remission
C91.A2 Mature B-cell leukemia Burkitt-type, in relapse
C91.Z0 Other lymphoid leukemia not having achieved remission
C91.Z1 Other lymphoid leukemia, in remission
C91.Z2 Other lymphoid leukemia, in relapse
C91.90 Lymphoid leukemia, unspecified not having achieved remission
C91.91 Lymphoid leukemia, unspecified, in remission
C91.92 Lymphoid leukemia, unspecified, in relapse
C92.00 Acute myeloblastic leukemia, not having achieved remission
C92.01 Acute myeloblastic leukemia, in remission
C92.02 Acute myeloblastic leukemia, in relapse
C92.10 Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission
C92.11 Chronic myeloid leukemia, BCR/ABL-positive, in remission
C92.12 Chronic myeloid leukemia, BCR/ABL-positive, in relapse
C92.20 Atypical chronic myeloid leukemia, BCR/ABL-negative, not having achieved remission
C92.21 Atypical chronic myeloid leukemia, BCR/ABL-negative, in remission
C92.22 Atypical chronic myeloid leukemia, BCR/ABL-negative, in relapse
C92.30 Myeloid sarcoma, not having achieved remission
C92.31 Myeloid sarcoma, in remission
C92.32 Myeloid sarcoma, in relapse
C92.40 Acute promyelocytic leukemia, not having achieved remission
C92.41 Acute promyelocytic leukemia, in remission
C92.42 Acute promyelocytic leukemia, in relapse
C92.50 Acute myelomonocytic leukemia, not having achieved remission
C92.51 Acute myelomonocytic leukemia, in remission
C92.52 Acute myelomonocytic leukemia, in relapse
C92.60 Acute myeloid leukemia with 11q23-abnormality not having achieved remission
C92.61 Acute myeloid leukemia with 11q23-abnormality in remission
C92.62 Acute myeloid leukemia with 11q23-abnormality in relapse
C92.A0 Acute myeloid leukemia with multilineage dysplasia, not having achieved remission
C92.A1 Acute myeloid leukemia with multilineage dysplasia, in remission
C92.A2 Acute myeloid leukemia with multilineage dysplasia, in relapse
C92.Z0 Other myeloid leukemia not having achieved remission
C92.Z1 Other myeloid leukemia, in remission
C92.Z2 Other myeloid leukemia, in relapse
C92.90 Myeloid leukemia, unspecified, not having achieved remission
C92.91 Myeloid leukemia, unspecified in remission
C92.92 Myeloid leukemia, unspecified in relapse
C93.00 Acute monoblastic/monocytic leukemia, not having achieved remission
C93.01 Acute monoblastic/monocytic leukemia, in remission
C93.02 Acute monoblastic/monocytic leukemia, in relapse
C93.10 Chronic myelomonocytic leukemia not having achieved remission
C93.11 Chronic myelomonocytic leukemia, in remission
C93.12 Chronic myelomonocytic leukemia, in relapse
C93.30 Juvenile myelomonocytic leukemia, not having achieved remission
C93.31 Juvenile myelomonocytic leukemia, in remission
C93.32 Juvenile myelomonocytic leukemia, in relapse
C93.Z0 Other monocytic leukemia, not having achieved remission
C93.Z1 Other monocytic leukemia, in remission
C93.Z2 Other monocytic leukemia, in relapse
C93.90 Monocytic leukemia, unspecified, not having achieved remission
C93.91 Monocytic leukemia, unspecified in remission
C93.92 Monocytic leukemia, unspecified in relapse
C94.00 Acute erythroid leukemia, not having achieved remission
C94.01 Acute erythroid leukemia, in remission
C94.02 Acute erythroid leukemia, in relapse
C94.20 Acute megakaryoblastic leukemia not having achieved remission
C94.21 Acute megakaryoblastic leukemia, in remission
C94.22 Acute megakaryoblastic leukemia, in relapse
C94.30 Mast cell leukemia not having achieved remission
C94.31 Mast cell leukemia, in remission
C94.32 Mast cell leukemia, in relapse
C94.40 Acute panmyelosis with myelofibrosis not having achieved remission
C94.41 Acute panmyelosis with myelofibrosis, in remission
C94.42 Acute panmyelosis with myelofibrosis, in relapse
C94.80 Other specified leukemias not having achieved remission
C94.81 Other specified leukemias, in remission
C94.82 Other specified leukemias, in relapse
C95.00 Acute leukemia of unspecified cell type not having achieved remission
C95.01 Acute leukemia of unspecified cell type, in remission
C95.02 Acute leukemia of unspecified cell type, in relapse
C95.10 Chronic leukemia of unspecified cell type not having achieved remission
C95.11 Chronic leukemia of unspecified cell type, in remission
C95.12 Chronic leukemia of unspecified cell type, in relapse
C95.90 Leukemia, unspecified not having achieved remission
C95.91 Leukemia, unspecified, in remission
C95.92 Leukemia, unspecified, in relapse
C96.4 Sarcoma of dendritic cells (accessory cells)
C96.Z Other specified malignant neoplasms of lymphoid, hematopoietic and related tissue
C96.9 Malignant neoplasm of lymphoid, hematopoietic and related tissue, unspecified
D45 Polycythemia vera
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.20 Refractory anemia with excess of blasts, unspecified
D46.21 Refractory anemia with excess of blasts 1
D46.22 Refractory anemia with excess of blasts 2
D46.A Refractory cytopenia with multilineage dysplasia
D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality
D46.4 Refractory anemia, unspecified
D46.Z Other myelodysplastic syndromes
D46.9 Myelodysplastic syndrome, unspecified
D47.1 Chronic myeloproliferative disease
D47.4 Osteomyelofibrosis
D56.0 Alpha thalassemia
D56.1 Beta thalassemia
D56.2 Delta-beta thalassemia
D56.3 Thalassemia minor
D56.5 Hemoglobin E-beta thalassemia
D56.9 Thalassemia, unspecified
D57.00 Hb-SS disease with crisis, unspecified
D57.01 Hb-SS disease with acute chest syndrome
D57.02 Hb-SS disease with splenic sequestration
D57.03 Hb-SS disease with cerebral vascular involvement
D57.09 Hb-SS disease with crisis with other specified complication
D57.1 Sickle-cell disease without crisis
D57.20 Sickle-cell/Hb-C disease without crisis
D57.211 Sickle-cell/Hb-C disease with acute chest syndrome
D57.212 Sickle-cell/Hb-C disease with splenic sequestration
D57.213 Sickle-cell/Hb-C disease with cerebral vascular involvement
D57.218 Sickle-cell/Hb-C disease with crisis with other specified complication
D57.219 Sickle-cell/Hb-C disease with crisis, unspecified
D57.40 Sickle-cell thalassemia without crisis
D57.411 Sickle-cell thalassemia, unspecified, with acute chest syndrome
D57.412 Sickle-cell thalassemia, unspecified, with splenic sequestration
D57.413 Sickle-cell thalassemia, unspecified, with cerebral vascular involvement
D57.418 Sickle-cell thalassemia, unspecified, with crisis with other specified complication
D57.419 Sickle-cell thalassemia, unspecified, with crisis
D57.42 Sickle-cell thalassemia beta zero without crisis
D57.431 Sickle-cell thalassemia beta zero with acute chest syndrome
D57.432 Sickle-cell thalassemia beta zero with splenic sequestration
D57.433 Sickle-cell thalassemia beta zero with cerebral vascular involvement
D57.438 Sickle-cell thalassemia beta zero with crisis with other specified complication
D57.439 Sickle-cell thalassemia beta zero with crisis, unspecified
D57.44 Sickle-cell thalassemia beta plus without crisis
D57.451 Sickle-cell thalassemia beta plus with acute chest syndrome
D57.452 Sickle-cell thalassemia beta plus with splenic sequestration
D57.453 Sickle-cell thalassemia beta plus with cerebral vascular involvement
D57.458 Sickle-cell thalassemia beta plus with crisis with other specified complication
D57.459 Sickle-cell thalassemia beta plus with crisis, unspecified
D57.80 Other sickle-cell disorders without crisis
D57.811 Other sickle-cell disorders with acute chest syndrome
D57.812 Other sickle-cell disorders with splenic sequestration
D57.813 Other sickle-cell disorders with cerebral vascular involvement
D57.818 Other sickle-cell disorders with crisis with other specified complication
D57.819 Other sickle-cell disorders with crisis, unspecified
D60.0 Chronic acquired pure red cell aplasia
D60.1 Transient acquired pure red cell aplasia
D60.8 Other acquired pure red cell aplasias
D60.9 Acquired pure red cell aplasia, unspecified
D61.01 Constitutional (pure) red blood cell aplasia
D61.09 Other constitutional aplastic anemia
D61.1 Drug-induced aplastic anemia
D61.2 Aplastic anemia due to other external agents
D61.3 Idiopathic aplastic anemia
D61.810 Antineoplastic chemotherapy induced pancytopenia
D61.811 Other drug-induced pancytopenia
D61.818 Other pancytopenia
D61.82 Myelophthisis
D61.89 Other specified aplastic anemias and other bone marrow failure syndromes
D61.9 Aplastic anemia, unspecified
D75.81 Myelofibrosis
D81.0 Severe combined immunodeficiency [SCID] with reticular dysgenesis
D81.1 Severe combined immunodeficiency [SCID] with low T- and B-cell numbers
D81.2 Severe combined immunodeficiency [SCID] with low or normal B-cell numbers
D81.6 Major histocompatibility complex class I deficiency
D81.7 Major histocompatibility complex class II deficiency
D81.89 Other combined immunodeficiencies
D81.9 Combined immunodeficiency, unspecified
D82.0 Wiskott-Aldrich syndrome
Z00.6 Encounter for examination for normal comparison and control in clinical research program

Group 2

(389 Codes)
Group 2 Paragraph

For recurrent or refractory neuroblastoma, use the appropriate code (see ICD-10-CM neoplasm by site, malignant).

For autologous progenitor cell transplantation, CPT code 38241:

Group 2 Codes
CodeDescription
C47.0 Malignant neoplasm of peripheral nerves of head, face and neck
C47.11 Malignant neoplasm of peripheral nerves of right upper limb, including shoulder
C47.12 Malignant neoplasm of peripheral nerves of left upper limb, including shoulder
C47.21 Malignant neoplasm of peripheral nerves of right lower limb, including hip
C47.22 Malignant neoplasm of peripheral nerves of left lower limb, including hip
C47.3 Malignant neoplasm of peripheral nerves of thorax
C47.4 Malignant neoplasm of peripheral nerves of abdomen
C47.5 Malignant neoplasm of peripheral nerves of pelvis
C47.6 Malignant neoplasm of peripheral nerves of trunk, unspecified
C47.8 Malignant neoplasm of overlapping sites of peripheral nerves and autonomic nervous system
C62.01 - C62.02 Malignant neoplasm of undescended right testis - Malignant neoplasm of undescended left testis
C62.11 - C62.12 Malignant neoplasm of descended right testis - Malignant neoplasm of descended left testis
C62.91 - C62.92 Malignant neoplasm of right testis, unspecified whether descended or undescended - Malignant neoplasm of left testis, unspecified whether descended or undescended
C72.0 Malignant neoplasm of spinal cord
C72.1 Malignant neoplasm of cauda equina
C72.21 Malignant neoplasm of right olfactory nerve
C72.22 Malignant neoplasm of left olfactory nerve
C72.31 Malignant neoplasm of right optic nerve
C72.32 Malignant neoplasm of left optic nerve
C72.41 Malignant neoplasm of right acoustic nerve
C72.42 Malignant neoplasm of left acoustic nerve
C72.59 Malignant neoplasm of other cranial nerves
C74.11 Malignant neoplasm of medulla of right adrenal gland
C74.12 Malignant neoplasm of medulla of left adrenal gland
C81.01 - C81.09 Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of head, face, and neck - Nodular lymphocyte predominant Hodgkin lymphoma, extranodal and solid organ sites
C81.11 - C81.19 Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, and neck - Nodular sclerosis Hodgkin lymphoma, extranodal and solid organ sites
C81.21 - C81.29 Mixed cellularity Hodgkin lymphoma, lymph nodes of head, face, and neck - Mixed cellularity Hodgkin lymphoma, extranodal and solid organ sites
C81.31 - C81.39 Lymphocyte depleted Hodgkin lymphoma, lymph nodes of head, face, and neck - Lymphocyte depleted Hodgkin lymphoma, extranodal and solid organ sites
C81.41 - C81.49 Lymphocyte-rich Hodgkin lymphoma, lymph nodes of head, face, and neck - Lymphocyte-rich Hodgkin lymphoma, extranodal and solid organ sites
C81.71 - C81.78 Other Hodgkin lymphoma, lymph nodes of head, face, and neck - Other Hodgkin lymphoma, lymph nodes of multiple sites
C82.01 - C82.09 Follicular lymphoma grade I, lymph nodes of head, face, and neck - Follicular lymphoma grade I, extranodal and solid organ sites
C82.11 - C82.19 Follicular lymphoma grade II, lymph nodes of head, face, and neck - Follicular lymphoma grade II, extranodal and solid organ sites
C82.21 - C82.29 Follicular lymphoma grade III, unspecified, lymph nodes of head, face, and neck - Follicular lymphoma grade III, unspecified, extranodal and solid organ sites
C82.31 - C82.39 Follicular lymphoma grade IIIa, lymph nodes of head, face, and neck - Follicular lymphoma grade IIIa, extranodal and solid organ sites
C82.41 - C82.49 Follicular lymphoma grade IIIb, lymph nodes of head, face, and neck - Follicular lymphoma grade IIIb, extranodal and solid organ sites
C82.51 - C82.59 Diffuse follicle center lymphoma, lymph nodes of head, face, and neck - Diffuse follicle center lymphoma, extranodal and solid organ sites
C82.61 - C82.69 Cutaneous follicle center lymphoma, lymph nodes of head, face, and neck - Cutaneous follicle center lymphoma, extranodal and solid organ sites
C82.81 - C82.89 Other types of follicular lymphoma, lymph nodes of head, face, and neck - Other types of follicular lymphoma, extranodal and solid organ sites
C82.91 - C82.99 Follicular lymphoma, unspecified, lymph nodes of head, face, and neck - Follicular lymphoma, unspecified, extranodal and solid organ sites
C83.01 - C83.09 Small cell B-cell lymphoma, lymph nodes of head, face, and neck - Small cell B-cell lymphoma, extranodal and solid organ sites
C83.11 - C83.19 Mantle cell lymphoma, lymph nodes of head, face, and neck - Mantle cell lymphoma, extranodal and solid organ sites
C83.31 - C83.39 Diffuse large B-cell lymphoma, lymph nodes of head, face, and neck - Diffuse large B-cell lymphoma, extranodal and solid organ sites
C83.51 - C83.59 Lymphoblastic (diffuse) lymphoma, lymph nodes of head, face, and neck - Lymphoblastic (diffuse) lymphoma, extranodal and solid organ sites
C83.71 - C83.79 Burkitt lymphoma, lymph nodes of head, face, and neck - Burkitt lymphoma, extranodal and solid organ sites
C83.81 - C83.89 Other non-follicular lymphoma, lymph nodes of head, face, and neck - Other non-follicular lymphoma, extranodal and solid organ sites
C83.91 - C83.99 Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of head, face, and neck - Non-follicular (diffuse) lymphoma, unspecified, extranodal and solid organ sites
C84.01 - C84.09 Mycosis fungoides, lymph nodes of head, face, and neck - Mycosis fungoides, extranodal and solid organ sites
C84.11 - C84.19 Sezary disease, lymph nodes of head, face, and neck - Sezary disease, extranodal and solid organ sites
C84.41 - C84.49 Peripheral T-cell lymphoma, not classified, lymph nodes of head, face, and neck - Peripheral T-cell lymphoma, not classified, extranodal and solid organ sites
C84.61 - C84.69 Anaplastic large cell lymphoma, ALK-positive, lymph nodes of head, face, and neck - Anaplastic large cell lymphoma, ALK-positive, extranodal and solid organ sites
C84.71 - C84.79 Anaplastic large cell lymphoma, ALK-negative, lymph nodes of head, face, and neck - Anaplastic large cell lymphoma, ALK-negative, extranodal and solid organ sites
C84.7A Anaplastic large cell lymphoma, ALK-negative, breast
C84.A1 - C84.A9 Cutaneous T-cell lymphoma, unspecified lymph nodes of head, face, and neck - Cutaneous T-cell lymphoma, unspecified, extranodal and solid organ sites
C84.Z1 - C84.Z9 Other mature T/NK-cell lymphomas, lymph nodes of head, face, and neck - Other mature T/NK-cell lymphomas, extranodal and solid organ sites
C84.91 - C84.99 Mature T/NK-cell lymphomas, unspecified, lymph nodes of head, face, and neck - Mature T/NK-cell lymphomas, unspecified, extranodal and solid organ sites
C85.11 - C85.19 Unspecified B-cell lymphoma, lymph nodes of head, face, and neck - Unspecified B-cell lymphoma, extranodal and solid organ sites
C85.21 - C85.29 Mediastinal (thymic) large B-cell lymphoma, lymph nodes of head, face, and neck - Mediastinal (thymic) large B-cell lymphoma, extranodal and solid organ sites
C85.81 - C85.89 Other specified types of non-Hodgkin lymphoma, lymph nodes of head, face, and neck - Other specified types of non-Hodgkin lymphoma, extranodal and solid organ sites
C86.0 - C86.6 Extranodal NK/T-cell lymphoma, nasal type - Primary cutaneous CD30-positive T-cell proliferations
C88.0 Waldenstrom macroglobulinemia
C88.2 Heavy chain disease
C88.3 Immunoproliferative small intestinal disease
C88.4 Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue [MALT-lymphoma]
C88.8 Other malignant immunoproliferative diseases
C88.9 Malignant immunoproliferative disease, unspecified
C90.00 Multiple myeloma not having achieved remission
C90.01 Multiple myeloma in remission
C90.02 Multiple myeloma in relapse
C90.10 Plasma cell leukemia not having achieved remission
C90.11 Plasma cell leukemia in remission
C90.20 Extramedullary plasmacytoma not having achieved remission
C90.21 Extramedullary plasmacytoma in remission
C90.22 Extramedullary plasmacytoma in relapse
C90.30 Solitary plasmacytoma not having achieved remission
C90.31 Solitary plasmacytoma in remission
C90.32 Solitary plasmacytoma in relapse
C91.01 Acute lymphoblastic leukemia, in remission
C91.11 Chronic lymphocytic leukemia of B-cell type in remission
C91.31 Prolymphocytic leukemia of B-cell type, in remission
C91.51 Adult T-cell lymphoma/leukemia (HTLV-1-associated), in remission
C91.61 Prolymphocytic leukemia of T-cell type, in remission
C91.A1 Mature B-cell leukemia Burkitt-type, in remission
C91.Z1 Other lymphoid leukemia, in remission
C92.01 Acute myeloblastic leukemia, in remission
C92.11 Chronic myeloid leukemia, BCR/ABL-positive, in remission
C92.21 Atypical chronic myeloid leukemia, BCR/ABL-negative, in remission
C92.31 Myeloid sarcoma, in remission
C92.41 Acute promyelocytic leukemia, in remission
C92.51 Acute myelomonocytic leukemia, in remission
C92.61 Acute myeloid leukemia with 11q23-abnormality in remission
C92.A1 Acute myeloid leukemia with multilineage dysplasia, in remission
C92.Z1 Other myeloid leukemia, in remission
C93.01 Acute monoblastic/monocytic leukemia, in remission
C93.11 Chronic myelomonocytic leukemia, in remission
C93.31 Juvenile myelomonocytic leukemia, in remission
C93.Z1 Other monocytic leukemia, in remission
C94.01 Acute erythroid leukemia, in remission
C94.21 Acute megakaryoblastic leukemia, in remission
C94.31 Mast cell leukemia, in remission
C94.81 Other specified leukemias, in remission
C95.01 Acute leukemia of unspecified cell type, in remission
C95.11 Chronic leukemia of unspecified cell type, in remission
C96.0 Multifocal and multisystemic (disseminated) Langerhans-cell histiocytosis
C96.21 Aggressive systemic mastocytosis
C96.22 Mast cell sarcoma
C96.29 Other malignant mast cell neoplasm
C96.4 Sarcoma of dendritic cells (accessory cells)
C96.5 Multifocal and unisystemic Langerhans-cell histiocytosis
C96.6 Unifocal Langerhans-cell histiocytosis
C96.A Histiocytic sarcoma
C96.Z Other specified malignant neoplasms of lymphoid, hematopoietic and related tissue
D45 Polycythemia vera
D47.Z9 Other specified neoplasms of uncertain behavior of lymphoid, hematopoietic and related tissue
E85.4 Organ-limited amyloidosis
E85.81 Light chain (AL) amyloidosis
E85.89 Other amyloidosis
E85.9 Amyloidosis, unspecified

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Revenue codes only apply to providers who bill these services to the Part A MAC. Revenue codes do not apply to physicians, other professionals and suppliers who bill these services to the Part B MAC

Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.

All revenue codes billed on the inpatient claim for the dates of service in question may be subject to review.


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Other Coding Information

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Revision History Information

Revision History DateRevision History NumberRevision History Explanation
04/01/2022 R16

Based on Transmittal 11068, Change Request 12480 - International Classification of Diseases International Classification of Diseases April 2022, ICD-10 codes C47.9, C72.50, C72.9, C81.91, C81.92, C81.93, C81.94, C81.95, C81.96, C81.97, C81.98, C81.99, C85.91, C85.92, C85.93, C85.94, C85.96, C85.97, C85.98, C85.99, C95.91, C96.20, C93.91, C92.91, C91.91 and C96.9 have been removed from the Group 2 list effective 04/01/2022. ICD-10 code C85.95 has also been removed from the Group 2 list effective 04/01/2022.
11/23/2021 R15

Based on Transmittal 11068, Change Request 12480 - International Classification of Diseases International Classification of Diseases April 2022, Allogeneic ICD-10 PCS 30230G2, 30230G3, 30230Y2, 30230Y3,30240G2, 30240G3, 30240Y2,30240Y3 and Autologous ICD-10 PCS 30230C0, 30230G0, 30230Y0, 30240C0, 30240G0, 30240Y0 have been end-dated effective 9/30/2021.
10/01/2021 R14

Based on the annual ICD-10 code update, ICD-10 code C84.7A has been added to Group 2.
09/20/2021 R13

Based on Transmittal 10963, Change Request 12399 - International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs)—January 2022, the following ICD-10 codes C47.0, C47.11, C47.12, C47.21, C47.22, C47.3, C47.4, C47.5, C47.6, C47.8, C47.9, C72.0, C72.1, C72.21, C72.22, C72.31, C72.32, C72.41, C72.42, C72.50, C72.59, C72.9, C74.11 and C74.12 have been added to the Group 2 list effective for dates of service on or after 10/01/2015.
04/01/2021 R12

Based on Transmittal 10566, Change Request 12027 - International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs)—April 2021, ICD-10 codes D57.03, D57.09, D57.213, D57.218, D57.413, D57.418, D57.42, D57.431, D57.432, D57.433, D57.438, D57.439, D57.44, D57.451, D57.452, D57.453, D57.458 and D57.459, have been added to the Group 1 list effective for dates of service on or after 10/01/2020, ICD-10 procedure codes 30230C0, 30233C0, 30240C0, 30243C0 have been added to the code list for Hematopoietic Progenitor Cell (HPC);Autologous Transplantation effective for dates of service on or after 10/01/2020.
10/01/2020 R11

Based on the annual ICD-10 code update, the descriptor for ICD-10 codes D57.411, D57.412 and D57.419 has been changed in Group 1.
05/07/2020 R10

This article was converted to the new Billing and Coding Article format. The Bill type and Revenue codes have been removed from this article. Guidance on these codes is available in the Bill type and Revenue code sections.
10/01/2019 R9

Based on Transmittal 2348, Change Request 11392 - International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs): ICD-10 PCS codes 30250G1, 30250Y1, 30253G1, 30253Y1, 30260G1, 30260Y1, 30263G1, 30263Y1, 30250G0, 30250Y0, 30253G0, 30253Y0, 30260G0, 30260Y0, 30263G0 and 30263Y0 have been deleted effective 09/30/2019.
07/01/2019 R8

Based on Transmittal 2243, Change Request 11134 - International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs): ICD-10-CM code D47.1 has been added to the Group 1 code list for CPT code 38240 effective 07/01/2019. ICD-10-CM code D47.1 is payable for allogeneic SCT in a Clinical Trial (38240) for Myelofibrosis. Outdated information has been removed.
08/30/2018 R7

The descriptor for Revenue Code 0815 was changed.
10/01/2017 R6

Based on Transmittal 1975, Change Request 10318 - ICD-10 and Other Coding Revisions to National Coverage Determinations (NCDs): ICD-10-CM codes C96.20, C96.21, C96.22 and C96.29 have been added to the Group 2 codes effective for dates of service on or after 10/01/2017.
10/01/2017 R5

Based on the annual ICD-10-CM code update, ICD-10-CM codes C96.2 and E85.8 in Group 2 have been deleted. ICD-10-CM codes E85.81 and E85.89 have been added. 
01/01/2017 R4 Based on Transmittal 1792, Change Request 9861 - ICD-10 Coding Revisions to National Coverage Determination (NCDs):
    ICD-10-PCS Procedure codes: 30230G1, 30230Y1, 30233G1, 30233Y1, 30240G1, 30240Y1, 30243G1 and 30243Y1 have been deleted and replaced with 30230G2, 30230G3, 30230Y2, 30230Y3, 30233G2, 30233G3, 30233Y2, 30233Y3, 30240G2, 30240G3, 30240Y2, 30240Y3, 30243G2, 30243G3, 30243Y2 and 30243Y3, effective for dates of service on and after 10/01/2016. ICD-10-PCS code 30230AZ has been removed from the "Hematopoietic Progenitor Cell (HPC): Autologous Transplantation" list in the article.

    The following “unspecified site” ICD-10-CM codes have been removed from Group 2 effective for dates of service on or after 10/01/2015:
    C81.00, C81.10, C81.20, C81.30, C81.40, C81.70, C81.90, C82.00, C82.10, C82.20, C82.30, C82.40, C82.50, C82.60, C82.80, C82.90, C83.00, C83.10, C83.30, C83.50, C83.70, C83.80, C83.90, C84.40, C84.60, C84.70, C84.A0, C84.Z0, C84.90, C85.10, C85.20, C85.80 and C85.90.

    The following ICD-CM codes have been added to the Group 2 ICD-10-CM code list effective for dates of service on or after 10/01/2015: C84.01 - C84.09, C84.11-C84.19, C88.2, C88.3, C88.4, C88.8, C88.9, C90.10, C90.11, C90.20, C90.21, C90.22, C90.30, C90.31, C90.32, C91.11, C91.31, C91.51, C91.61, C91.A1, C91.Z1, C91.91, C92.11, C92.21, C92.31, C92.Z1, C92.91, C93.11, C93.31, C93.Z1, C93.91, C94.31, C94.81, C95.11, C95.91, C96.0, C96.2, C96.5, C96.6, C96.A and D45. ICD-10-CM codes, C94.41 and C81.79 have been removed effective for dates of service on or after 10/01/2015.

In order to be consistent with CR 9861, the following “unspecified site” ICD-10-CM codes have been removed from Group 1 effective for dates of service on or after 10/01/2015: C81.00, C81.10, C81.20, C81.30, C81.40, C81.70, C81.90, C82.00, C82.10, C82.20, C82.30, C82.40, C82.50, C82.60, C82.80, C82.90, C83.00, C83.10, C83.30, C83.50, C83.70, C83.80, C83.90, C84.40, C84.A0, C84.Z0, C84.90, C85.10, C85.20, C85.80 and C85.90 and the following “unspecified” ICD-10-CM codes have been removed from Group 2: C62.00, C62.10, C62.90.

ICD-10-CM code C94.42 has been added to the ICD-10 Group 1 paragraph section and to the Group 1 ICD-10-CM code list.

ICD-10-CM codes C90.01 and C94.21 are effective for dates of service on or after 10/01/2015 instead of 10/1/0216 as previously stated in Revision History Number 3. A reference for NCCN Clinical Practice Guidelines in Oncology has been added to the “Sources of Information” section in the article.

Based on Transmittal 3571, Change Request 9674 - New Revenue Code 0815 for Allogeneic Stem Cell Acquisition Services, Revenue code 0815 has been added to the “Revenue Code” section of the article effective 01/01/2017.
10/01/2016 R3 Based on CMS Transmittal No. 193, Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, and Transmittal No. 3556, Publication 100-04, Medicare Claims Processing Manual, Change Request #9620, the following updates have been added for allogeneic hematopoietic stem cell transplantation (HSCT) for myelodysplastic syndrome (MDS), effective for dates of service on or after 10/01/2015, multiple myeloma, myelofibrosis (MF) and sickle cell disease (SCD) effective for dates of service on or after 01/27/2016:
  • Indications for multiple myeloma, myelofibrosis (MF) and sickle cell disease (SCD) have been added to the "Indications" section of the article.
  • Guidelines for myelodysplastic syndrome (MDS), multiple myeloma, myelofibrosis (MF) and sickle cell disease (SCD) have been added to the "Specific coding guidelines" section of the article.
  • ICD-10-CM codes D46.0, D46.1, D46.20, D46.21, D46.22, D46.A, D46.B, D46.C, D46.4 have been added for allogeneic hematopoietic stem cell transplantation (HSCT) effective for dates of service on or after 10/01/2015.
    ICD-10-CM codes C90.00, C90.01, C90.02, C94.40, C94.41, D47.4, D57.00, D57.01, D57.02, D57.1, D57.20, D57.211, D57.212, D57.219, D57.40, D57.411, D57.412, D57.419, D57.80, D57.811, D57.812, D57.819 and D75.81 have been added for allogeneic hematopoietic stem cell transplantation (HSCT) and ICD-10-CM code D47.1 has been removed effective for dates of service on or after 01/27/2016.
  • ICD-10-CM codes C90.01, C94.21 and C94.41 have been added for autologous hematopoietic progenitor cell transplantation (HPC) effective for dates of service on or after 10/01/2016 and ICD-10-CM codes E85.1 and E85.2 have been removed.
Based on the annual ICD-10-CM code update, the descriptor was changed for ICD-10-CM codes in Group 1: C81.10, C81.19, C81.20, C81.29, C81.30 and C81.39.
10/01/2015 R2 ICD-10-PCS Procedure code 3023G1 has been corrected to 30233G1 in the "Indications" section of the article for "Hematopoietic Progenitor Cell (HPC);Allogeneic Transplantation". The following ICD-10-PCS Procedure codes (30233AZ, 30240AZ and 30243AZ) have been removed from the codes listed for "Hematopoietic Progenitor Cell (HPC);Autologous Transplantation" in the "Indications" section of the article.
10/01/2015 R1 The Indications and Sources of Information have been updated to include updates made to the ICD-9 version. The place of service guidelines for the Part B MAC have been removed. The following ICD-10 codes C84.00 - C84.19 have been removed from the Group 2: codes for CPT code 38241.

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