evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
large B -cell lymphoma, lymph nodes of  multiple  sites C85.29  Mediastinal (thymic) large B -cell lymphoma, extranodal and  solid  organ sites  C85.81  Other  specified  types  of non-Hodgkin  lymphoma,  lymph  nodes  of head,  face, and neck  C85.82  Other specified types of non -Hodgkin lymphoma, intrathoracic  lymph  nodes  C85.83  Other specified types of non-Hodgkin lymphoma, intra - abdominal  lymph nodes  C85.84  Other  specified  types  of non-Hodgkin  lymphoma,  lymph  nodes  of axilla  and upper limb  C85.85  Other  specified  types  of non-Hodgkin  lymphoma,  lymph  nodes  of inguinal  region and lower limb  C85.86  Other specified types of non -Hodgkin lymphoma, intrapelvic  lymph  nodes  C85.87  Other  specified  types  of non-Hodgkin  lymphoma,  spleen  C85.88  Other  specified  types  of non-Hodgkin  lymphoma,  lymph  nodes  of multiple  sites C85.89  Other specified types of non -Hodgkin lymphoma, extranodal and  solid  organ sites  C85.91  Non-Hodgkin  lymphoma, unspecified,  lymph  nodes  of head,  face,  and neck  C85.92  Non-Hodgkin  lymphoma, unspecified,  intrathoracic  lymph  nodes  C85.93  Non-Hodgkin  lymphoma,  unspecified,  intra-abdominal  lymph  nodes  C85.94  Non-Hodgkin lymphoma, unspecified, lymph nodes of axilla and  upper  limb C85.95  Non-Hodgkin lymphoma, unspecified, lymph nodes of inguinal  region  and lower limb  C85.96  Non-Hodgkin  lymphoma, unspecified,  intrapelvic  lymph  nodes  C85.97  Non-Hodgkin  lymphoma, unspecified,  spleen  C85.98  Non-Hodgkin lymphoma, unspecified, lymph nodes of multiple  sites C85.99  Non-Hodgkin lymphoma,
(Medicare Claims Processing Manual)
lymphoma, unspecified,  spleen  C85.98  Non-Hodgkin lymphoma, unspecified, lymph nodes of multiple  sites C85.99  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  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
(Medicare Claims Processing Manual)
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  C91.91  Lymphoid  leukemia,  unspecified,  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  C92.91  Myeloid  leukemia,  unspecified  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  C93.91  Monocytic  leukemia,  unspecified  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  C95.91  Leukemia,  unspecified,  in remission  C96.0  Multifocal
(Medicare Claims Processing Manual)
C95.01  Acute  leukemia  of unspecified  cell type,  in remission  C95.11  Chronic  leukemia  of unspecified  cell type, in  remission  C95.91  Leukemia,  unspecified,  in remission  C96.0  Multifocal  and multisystemic  (disseminated)  Langerhans -cell histiocytosis  C96.20  Malignant  mast  cell neoplasm,  unspecified  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  C96.9  Malignant neoplasm of lymphoid, hematopoietic and related  tissue,  unspecified  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
(Medicare Claims Processing Manual)
a. Effective  for services  performed on  or after April  28, 1989:   Acute leukemia in  remission  who have a high  probability of  relapse  and who have  no human  leucocyte antigens  (HLA)-  matched (ICD -10-CM diagnosis codes C91.01, C92.01, C92,41, C92.51, C92.61, C92.A1, C93.01, C94.01, C94.21, C94.41, C95.01);   Resistant non- Hodgkin's lymphomas or those presenting with poor prognostic  features following  an initial response  (ICD - 10-CM diagnosis codes C82.01- C85.29, C85.81- C86.6, C96.4, and C96.Z -C96.9);   Recurrent  or refractory  neuroblastoma  (see ICD -10-CM codes  Neoplasm by site, malignant for the appropriate diagnosis  code) following ranges are reported: C00 -  C96, and D00 -  D09 Resistant non-  Hodgkins lymphomas); or, Advanced Hodgkin's disease who have failed conventional therapy and  have no HLA -matched donor (ICD -10-CM codes C81.01 -  C81.99).   a. Effective  for services  performed on  or after October 1, 2000:   Single  AuSCT  is only covered  for Durie -Salmon  Stage II  or III multiple myeloma patients (ICD -10-CM codes C90.00, C90.01, C90.02 and D47.Z9) 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.    b. Effective  for services  performed on  or after March 15,  2005:
(Medicare Claims Processing Manual)
 Adequate  cardiac,  renal, pulmonary, and hepatic function.    b. 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  (ICD -10-CM codes  E85.4, E85.81, E85.89 and  E85.9)  who meet  the following criteria:    Amyloid  deposition  in 2 or fewer  organs;  and,   Cardiac left ventricular ejection  fraction  (EF)  greater  than 45%.   E85.4 Organ- limited amyloidosis   E85.81 Light  chain  (AL) amyloidosis  E85.89 Other  amyloidosis   E85.9 Amyloidosis, unspecified   As the applicable ICD -10 CM codes E85.4, E85.81, E85.9, and E85.89 for amyloidosis do not differentiate between primary and non- primary, A/B MACs (B) should perform prepay reviews on all claims with a diagnosis of ICD - 10-CM code  E85.4, E85.81, E85.9, and E85.89 to determine  whether  payment  is appropriate.  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 27, 2016, allogeneic HSCT is not covered as  treatment for multiple  myeloma  (if ICD-10-CM is applicable,  ICD- 10-CM codes C90.00, C90.01, C90.02 and D47.Z9).   II. Autologous  Stem  Cell Transplantation  (AuSCT)   AuSCT  is not considered reasonable and  necessary  within  the meaning  of l862(a)(1)(A)  of the Act and is not covered  under Medicare for the following conditions:     Acute leukemia not in remission prior to October 1, 2000 ( if  ICD-10-CM is applicable, ICD -10-CM codes C91.00, C92.00, C93.00, C94.00, and C95.00)
(Medicare Claims Processing Manual)
 Chronic  granulocytic  leukemia  prior  to October  1, 2000 (if ICD-10-CM is applicable,  ICD -10-CM code C92.10);   1.Solid  tumors  prior  to October  1, 2000 (other  than  neuroblastoma) (if ICD -10-CM is applicable, ICD -10- CM codes  C00.0  C80.2 and D00.0  D09.9);   2. Multiple myeloma prior to October 1, 2000 (if ICD -10-CM is applicable, ICD -10-CM codes C90.00, C90.01, C90.02 and D47.Z9);   3. Tandem transplantation, on or after October 1, 2000 (if ICD-10-CM is applicable, ICD -10-CM codes C90.00, C90.01, C90.02, and D47.Z9)  ; 4. Non- primary amyloidosis on or after 10/01/00, for all Medicare  beneficiaries   5. Primary AL amyloidosis effective October 1, 2000, through March  14, 2005 for Medicare beneficiaries  age                                 64. (if ICD -10-CM is applicable,  ICD -10-CM codes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        E85.4, E85.81, E85.9, and E85.89);                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               As the ICD -10-CM is applicable, as the applicable ICD -10 CM codes E85.4, E85.81, E85.9, and E85.89 for amyloidosis do not differentiate between primary and non- primary, A/B MACs (B) should perform prepay reviews on all claims with a diagnosis of ICD -10-CM code E85.4, E85.81, E85.9, and E85.89 to determine  whether  payment is appropriate.   2. Other   All other indications for stem cell transplantation not otherwise noted above as covered or non- covered remain at local Medicare Administrative  Contractor  discretion.   3. Suggested MSN  and RA Messages   The contractor shall use an appropriate MSN and CARC message  such as the following:   MSN  - 15.4, The  information provided does  not support  the need for  this service or  item;
(Medicare Claims Processing Manual)
3. Suggested MSN  and RA Messages   The contractor shall use an appropriate MSN and CARC message  such as the following:   MSN  - 15.4, The  information provided does  not support  the need for  this service or  item;  CARC -  150, Payment adjusted because the payer deems the  information  submitted  does  not support  this level  of service.   4. Clinical Trials for Allogeneic Hematopoietic Stem Cell  Transplantation (HSCT) for Myelodysplastic Syndrome  (MDS), Multiple Myeloma, Myelofibrosis (MF), and for  Sickle  Cell Disease  (SCD)    Background   Effective for services performed on or after August 4, 2010, contractors shall pay for claims for allogeneic HSCT for the treatment  of Myelodysplastic Syndromes (MDS) pursuant to Coverage with Evidence  Development  (CED) in the context  of a Medicare- approved,  prospective  clinical study.   Effective for services performed on or after January 27, 2016, contractors  shall  pay for claims  for allogeneic HSCT  for the treatment  of multiple myeloma, myelofibrosis (MF), and for sickle cell disease  (SCD) pursuant to CED, in the context of a Medicare -approved, prospective  clinical study.   Refer to Pub.100- 03, National Coverage Determinations Manual, Chapter 1, section 110.23, for more information about this policy, and Pub. 100 -04, Medicare Claims Processing Manual, Chapter 3,  section  90.3, for  information on inpatient billing  of this CED.    Adjudication Requirements   Payable Conditions. For claims with dates of service on and after August 4, 2010, contractors  shall  pay for claims  for allogeneic  HSCT for MDS when the service was provided pursuant to a  Medicare- approved clinical study under CED; these services are paid  only in the inpatient setting (Type of Bill (TOB) 11X), as outpatient  Part B (TOB 13X), and in Method II critical access hospitals (TOB  85X).   Contractors  shall require  the following coding in order  to pay for these claims:
(Medicare Claims Processing Manual)
Contractors  shall require  the following coding in order  to pay for these claims:    Existing Medicare -approved clinical trial coding conventions, as required in Pub. 100- 04, Medicare Claims  Processing Manual, Chapter 32, section 69, and inpatient  billing requirements regarding acquisition of stem cells in  Pub. 100-  04, Medicare Claims Processing Manual,  Chapter 3, section 90.3.1.     If ICD -10-CM is applicable, ICD -10-PCS, procedure  codes 30230G2, 30230G3, 30230Y2, 30230Y3, 30233G2, 30233G3, 30233Y2, 30233Y3, 30240G2, 30240G3, 30240Y2, 30240Y3, 30243G2, 30243G3, 30243Y2, and 30243Y3.    If Outpatient Hospital or Professional Claims: HCPCS  procedure  code 38240  If ICD -10-CM is applicable, 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.   Professional  claims  only:  place  of service codes  19, 21, or  22.  Payable Conditions. For claims with dates of service on and  after January 27, 2016, contractors shall pay for claims for  allogeneic HSCT for multiple myeloma, myelofibrosis (MF), and for sickle cell disease (SCD) when the service was provided  pursuant to a Medicare -approved clinical study under CED; these  services  are paid only in the inpatient  setting  (Type  of Bill (TOB) 11X), as outpatient Part B (TOB 13X), and in Method II critical  access  hospitals (TOB  85X).   Contractors  shall require  the following coding in order  to pay for these claims:    Existing Medicare -approved clinical trial coding conventions, as required in Pub. 100- 04, Medicare Claims  Processing Manual, Chapter 32, section 69, and inpatient  billing requirements regarding acquisition of stem cells in  Pub. 100-  04, Medicare Claims Processing Manual,  Chapter 3, section 90.3.1.
(Medicare Claims Processing Manual)
 ICD-10-PCS codes 30230G2, 30230G3, 30230Y2, 30230Y3, 30233G2, 30233G3, 30233Y2, 30233Y3, 30240G2, 30240G3, 30240Y2, 30240Y3, 30243G2, 30243G3, 30243Y2, and  30243Y3.   ICD-10-CM diagnosis codes C90.00, C90.01, C90.02, C94.40, C94.41, C94.42, D47.1, D47.4, D75.81, 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, and D57.459, D57.80, D57.811, D57.812, D57.813, D57.818, D57.819, and Z00.6.   If Outpatient Hospital or Professional Claims: HCPCS procedure code  38240    Professional  claims  only:  place  of service codes  19, 21, or  22.  Denials.  Contractors  shall  deny claims  failing  to meet any  of the above criteria.  In addition, contractors shall apply the  following requirements:    Providers shall issue a hospital issued notice of non-  coverage (HINN)  or advance  beneficiary  notice (ABN)  to the beneficiary if the services performed are not provided  in accordance with  CED.    Contractors  shall  deny claims  that do not  meet  the criteria  for coverage  with the  following messages:   CARC 50 -  These are non -covered services because this is not  deemed  a 'medical necessity'  by the payer.
(Medicare Claims Processing Manual)
 Contractors  shall  deny claims  that do not  meet  the criteria  for coverage  with the  following messages:   CARC 50 -  These are non -covered services because this is not  deemed  a 'medical necessity'  by the payer.   NOTE: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service  Payment Information  REF),  if present.   RARC N386 -  This decision was based on a National Coverage  Determination (NCD). An NCD provides a coverage determination  as to whether a particular item or service is covered. A copy of this  policy is available a  http:www.cms.hhs.gov/mcd/search.asp. If you  do not have web access, you may contact the contractor to request a copy of the NCD.   Group Code   Patient  Responsibility  (PR) if HINN/ABN issued, otherwise  Contractual Obligation (CO)   MSN 16.77  This service/item was not covered because it was  not provided as part of a qualifying trial/study. (Este  servicio/artculo no fue cubierto porque no estaba incluido como parte  de un ensayo  clnico/estudio calificado.)   MSN  15.20  The  following policies  [NCD  110.23] were  used when we made this decision. (Las siguientes polticas [NCD  110.23] fueron utilizadas cuando se  tom esta  decisin.)    90.1 - General  (Rev. 486, Issued: 03- 04-05, Effective Date/Implementation Date: N/A)   Allogeneic Stem Cell Transplantation.   Allogeneic stem cell transplantation is a procedure in which a portion of a healthy donors stem cells is obtained and prepared for intravenous infusion to restore normal hematopoietic function in recipients having an inherited or acquired hematopoietic de ficiency or defect.   Expenses incurred by a donor are a covered benefit to the recipient/beneficiary but, except for physician services, are not paid separately. Services to the donor include physician services, hospital care in connection with screening the stem cell, and ordinary follow -up care.
(Medicare Claims Processing Manual)
Autologous Stem Cell Transplantation  Autologous stem cell transplantations is a technique for restoring stem cells using the patients own previously stored cells. Autologous stem cell transplants are covered for certain specified diagnoses for services rendered on or after April 28, 1989.  90.2 - HCPCS and Diagnosis Coding  ICD-9-CM Applicable  (Rev.11035, Issued:10 -13-21, Effective:  11-17-21; Implementation:  11-21)  Allogeneic  Stem Cell Transplantation   Effective  for services  performed on or  after August  1, 1978:For the treatment of leukemia or leukemia in remission,  providers shall use appropriate ICD -10 diagnosis codes  noted in section 90 and HCPCS code  38240.  For the treatment of aplastic anemia, providers shall use  appropriate ICD -10 diagnosis codes noted in section 90 and HCPCS  code  38240.   Effective  for services  performed on or  after June 3,  1985:   For the treatment of severe combined immunodeficiency disease,  providers  shall  use appropriate  ICD -10 diagnosis  codes  noted in section 90 and HCPCS code  38240.   For the treatment of Wiskott- Aldrich syndrome, providers  shall use appropriate ICD -10-CM code D82.0 and HCPCS  code  38240.  Autologous Stem Cell Transplantation .--Is covered under the  following circumstances effective for services performed on or  after April 28, 1989:   For the treatment of patients with acute leukemia in remission  who have a high probability of relapse and who have no human leucocyte antigens (HLA) matched, providers shall use  appropriate ICD -10 diagnosis codes noted in section 90 for  lymphoid; myeloid; monocytic; acute erythremia; erythroleukemia;  unspecified  cell type and HCPCS  code  38241.  For the treatment  of resistant  non- Hodgkins  lymphomas  for those  patients presenting with poor prognostic features following an initial response, providers shall use appropriate ICD -10 diagnosis  codes  noted in section 90 and HCPCS code  38241.
(Medicare Claims Processing Manual)
For the treatment of recurrent or refractory neuroblastoma,  providers shall use ICD - 10-CM codes Neoplasm by site, malignant,  the appropriate  HCPCS code  and HCPCS code  38241.  For the treatment of advanced Hodgkins disease for patients who  have failed conventional therapy and have no HLA -matched  donor, providers shall use appropriate ICD -10 diagnosis codes  and HCPCS code  38241 Autologous Stem Cell Transplantation .--Is covered under the following circumstances effective for services furnished on or after October 1, 2000:  For the treatment of multiple myeloma (only for beneficiaries who  are less than age 78, have Durie-Salmon stage II or III newly  diagnosed or responsive multiple myeloma, and have adequate cardiac, renal, pulmonary and hepatic functioning), providers shall  use appropriate ICD-10- CM code and HCPCS code  38241.  For the treatment of recurrent or refractory neuroblastoma,  providers shall use appropriate code (see ICD-10-CM neoplasm by site, malignant)  and HCPCS code 38241.  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 autologous stem cell transplantation (HDM/AuSCT) is  reasonable and necessary for Medicare beneficiaries of any age group for the treatment of primary amyloid light chain (AL) amyloidosis, ICD-10- CM codes E85.4, E85.81, E85.9, and E85.89  who  meet the following  criteria:   Amyloid  deposition in 2 or fewer  organs; and,  Cardiac left ventricular  ejection  fraction  (EF) greater  than  45%.  90.2.1 - HCPCS and Diagnosis Coding for Stem Cell Transplantation - ICD-10-CM Applicable  (Rev.  11035, Issued:10 -13-21, Effective: 11-17-21; Implementation:  11-17-21)  ICD-10 is applicable to services on and after the implementation of ICD-.   For services provided use the appropriate code from  the ICD -10 CM  codes the table  below..  See 90.2 for a list of covered  conditions