(Medicare Claims Processing Manual)

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.  f. 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, D57.819, and Z00.6)                    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                     i nformation about this policy. See section F below for billing                                                                                                                                       instructions. II. Autologous  Stem  Cell Transplantation  (AuSCT)   HCPCS  Code  38241   ICD-10-PCS Procedure  Codes:    30230C0  Transfusion of Autologous Hematopoietic Stem/Progenitor Cells,  Genetically  Modified  into Peripheral  Vein,  Open  Approach  30230G0  Transfusion  of Autologous  Bone  Marrow  into Peripheral  Vein,  Open  Approach  30230Y0  Transfusion of Autologous Hematopoietic Stem Cells into  Peripheral  Vein, Open Approach  30233G0  Transfusion  of Autologous  Bone  Marrow  into Peripheral  Vein,  Percutaneous  Approach  30233C0  Transfusion of Autologous Hematopoietic Stem/Progenitor Cells,  Genetically  Modified  into Peripheral  Vein,  Percutaneous  Approach  30233Y0  Transfusion of Autologous Hematopoietic Stem Cells into  Peripheral  Vein, Percutaneous Approach  30240C0  Transfusion of Autologous Hematopoietic Stem/Progenitor Cells,  Genetically  Modified into Central Vein,  Open Approach  30240G0  Transfusion  of Autologous  Bone  Marrow  into Central  Vein,  Open  Approach  30240Y0  Transfusion of Autologous Hematopoietic Stem Cells into Central  Vein,  Open Approach  30243C0  Transfusion of Autologous Hematopoietic Stem/Progenitor Cells,  Genetically  Modified into Central  Vein,  Percutaneous  Approach  30243G0  Transfusion of Autologous Bone Marrow into Central Vein,  Percutaneous  Approach  30243Y0  Transfusion of Autologous Hematopoietic Stem Cells into Central  Vein,  Percutaneous Approach  Below ICD -10 CM codes Cover autologous SCT (38241) no trial for acute  leukemia in remission, resistant non- Hodgkins lymphomas, recurrent/refractory  neuroblastoma, advanced Hodgkins Disease on or after 4/28/89, and Cover  autologous SCT (38241) no trial for Durie -Salmon stage II/III responsive multiple  myeloma and responsive relapse on or after 10/1/00 over autologous SCT  (38241) together with high dose melphalan (HDMI) no trial for primary amyloid  light  chain (AL)  amyloidosis on or after 3/15/05