(Medicare Claims Processing Manual)

HCPCS  Code  38240   See below  table  for ICD-10-DX Codes:   a. Effective  for services  performed on  or after August  1, 1978:   a. For the treatment of leukemia, leukemia in remission; see table below for ICD - 10-CM codes:   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  C91.90  Lymphoid  leukemia,  unspecified  not having  achieved  remission  C91.91  Lymphoid  leukemia,  unspecified,  in remission  C91.92  Lymphoid  leukemia,  unspecified,  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  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  C92.90  Myeloid  leukemia,  unspecified,  not having  achieved  remission  C92.91  Myeloid  leukemia,  unspecified  in remission  C92.92  Myeloid  leukemia,  unspecified  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  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  C93.90  Monocytic  leukemia,  unspecified,  not having  achieved  remission  C93.91  Monocytic  leukemia,  unspecified  in remission  C93.92  Monocytic  leukemia,  unspecified  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  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  C94.80  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  D45 Polycythemia vera   ii. For the treatment of aplastic anemia; see table below for ICD -10- CM codes)   ICD-10 Description  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  b. Effective  for services performed  on or after  June  3, 1985:    c. For the treatment of severe combined immunodeficiency disease (SCID) (ICD -10-CM codes D81.0, D81.1, D81.2, D81.6, D81.7, D81.89, and D81.9)  d. For the treatment of Wiskott -Aldrich syndrome ( ICD -10- CM code  D82.0)     c.    Effective  for services  performed on or after August 4, 2010:   For the treatment  of Myelodysplastic  Syndromes  (MDS) (ICD -10- CM codes  D46.A, D46.B, D46.C, D46.Z, D46.0, D46.1, D46.4, D46.9, D46.20, D46.21, D46.22, and Z00.6) 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. See section F  below  for billing  instructions.            d.   Effective  for services  performed  on or after  January 27, 2016:    b. Allogeneic HSCT for multiple myeloma (ICD -10-CM codes  C90.00, C90.01, C90.02, and Z00.6) 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. See section F below for billing instructions.  e. Allogeneic HSCT for myelofibrosis (MF) (ICD -10-CM codes  C94.40, C94.41, C94.42, D47.1, D47.4, D75.81, and Z00.6) 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. See section F below for  billing instructions.