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Transplant Section

Policy Name	Policy ID Number	Date Modified
Donor Lymphocyte Infusion for Malignancies Treated with an Allogeneic Hematopoietic Cell Transplant	TRA45.03	12/01/2023
Heart Transplant	TRA02	12/01/2023
Heart-Lung Transplant	TRA03	06/01/2023
Hematopoietic Cell Transplantation Policies
Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms	TRA45.24	11/01/2023
Allogeneic Hematopoietic Cell Transplantation for Genetic Diseases and Acquired Anemias	TRA45.25	03/01/2024
Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia	TRA45.36	01/01/2024
Hematopoietic Cell Transplantation for Acute Myeloid Leukemia	TRA45.28	04/01/2024
Hematopoietic Cell Transplantation for Autoimmune Diseases	TRA45.32	07/01/2023
Hematopoietic Cell Transplantation for Central Nervous System Embryonal Tumors and Ependymoma	TRA45.33	12/01/2023
Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma	TRA45.35	01/01/2024
Hematopoietic Cell Transplantation for Chronic Myelogenous Leukemia	TRA45.31	11/01/2023
Hematopoietic Cell Transplantation for Hodgkin Lymphoma	TRA45.30	11/01/2023
Hematopoietic Cell Transplantation for Light-Chain (AL) Amyloidosis or Waldenström Macroglobulinemia	TRA45.40	07/01/2023
Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults	TRA45.27	03/01/2024
Hematopoietic Cell Transplantation for Multiple Myeloma and POEMS Syndrome	TRA45.22	12/01/2023
Hematopoietic Cell Transplantation for Non-Hodgkin's Lymphomas	TRA45.23	03/01/2024
Hematopoietic Cell Transplantation for Solid Tumors of Childhood	TRA45.37	12/01/2023
Hematopoietic Cell Transplantation in the Treatment of Germ-Cell Tumors	TRA45.38	11/01/2023
Islet Transplantation	TRA13	07/01/2023
Small Bowel, Small Bowel/Liver, and Multivisceral Transplant	TRA09	04/01/2024
Liver Transplant	TRA05	07/01/2023
Lung and Lobar Lung Transplant	TRA08	06/01/2023
Pancreas Transplant	TRA06	11/01/2023
Placental and Umbilical Cord Blood as a Source of Stem Cells	TRA45.16	05/01/2023
Uterus Transplant	TRA19	09/01/2023


	The Blue Cross and/or Blue Shield Plans comprising The Regence Group serve Idaho, Oregon, Utah and much of Washington state. The Regence Group and each of its affiliate Plans are independent licensees of the Blue Cross and Blue Shield Association.