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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
 
 
The rules say that II. Autologous Stem Cell Transplantation (AuSCT) 
 
a)   Effective for services performed on or after April 28, 1989, AuSCT is considered reasonable and necessary 
under ?l862(a)(1)(A) of the Act for the following conditions and is covered under Medicare for patients with: 
 
    1. Acute leukemia in remission who have a high probability of relapse and who have no human leucocyte 
antigens (HLA)-matched; 
 
    2. Resistant non-Hodgkin's lymphomas or those presenting with poor prognostic features following an initial 
response; 
 
   3. Recurrent or refractory neuroblastoma; or, 
 
    4. Advanced Hodgkin's disease who have failed conventional therapy and have no HLA-matched donor. 
 
b)   Effective October 1, 2000, single AuSCT 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. 
 
c)   Effective for services performed on or after March 15, 2005, when recognized clinical risk factors are 
employed to select patients for transplantation, high dose melphalan (HDM) together with AuSCT is 
reasonable and necessary for Medicare beneficiaries of any age group with primary amyloid light chain (AL) 
amyloidosis who meet the following criteria: 
 
    Amyloid deposition in 2 or fewer organs; and, 
    Cardiac left ventricular ejection fraction (EF) greater than 45% 
 
C.      Nationally Non-Covered Indications 
 
I. Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) 
 
Effective for claims with dates of service on or after May 24, 1996, through January 26, 2016, allogeneic 
HSCT is not covered as treatment for multiple myeloma. 
 
II. Autologous Stem Cell Transplantation (AuSCT) 
 
Insufficient data exist to establish definite conclusions regarding the efficacy of AuSCT for the following 
conditions: 
a)  Acute leukemia not in remission; 
b)  Chronic granulocytic leukemia; 
c)  Solid tumors (other than neuroblastoma); 
d)  Up to October 1, 2000, multiple myeloma; 
e)  Tandem transplantation (multiple rounds of AuSCT) for patients with multiple myeloma; 
f)  Effective October 1, 2000, non primary AL amyloidosis; and, 
g)  Effective October 1, 2000, through March 14, 2005, primary AL amyloidosis for Medicare beneficiaries age 
 
 
64 or older. 
 
In these cases, AuSCT is not considered reasonable and necessary within the meaning of ?l862(a)(1)(A) of the 
Act and is not covered under Medicare. 
 
D.       Other 
 
All other indications for stem cell transplantation not otherwise noted above as covered or non-covered remain 
at local Medicare Administrative Contractor discretion. 
 
You can find this information in Medicare's National Coverage Determination (NCD) for Stem Cell 
Transplantation (Formerly 110.8.1) (110.23). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.