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Medical Policy

Transplant Section

Policy Name Date Modified
Donor Lymphocyte Infusion for Malignancies Treated with an Allogeneic Hematopoietic Stem-Cell Transplant 01/01/2013

Heart, Lung, and Heart-Lung Transplant

9/1/2013 Effective Policies:
Heart Transplant

Heart/Lung Transplant

Lung and Lobar Lung Transplant

06/01/2013
Hematopoietic Stem-Cell Transplantation Index 12/01/2012

Allogeneic Hematopoietic Stem-Cell Transplantation for Genetic Diseases and Acquired Anemias

04/01/2013

Allogeneic Stem-Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms

01/01/2013

Autologous Hematopoietic Stem-Cell Transplantation for Malignant Astrocytomas and Gliomas

04/01/2013

Hematopoietic Stem-Cell Transplantation for Acute Lymphoblastic Leukemia

01/01/2013

Hematopoietic Stem-Cell Transplantation for Acute Myeloid Leukemia

04/01/2013

Hematopoietic Stem-Cell Transplantation for Autoimmune Diseases

01/01/2013

Hematopoietic Stem-Cell Transplantation for Breast Cancer

04/01/2013

Hematopoietic Stem-Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma

01/01/2013

Hematopoietic Stem-Cell Transplantation for Chronic Myelogenous Leukemia

01/01/2013

Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma

01/01/2013

Hematopoietic Stem-Cell Transplantation for Epithelial Ovarian Cancer

01/01/2013

Hematopoietic Stem-Cell Transplantation for Hodgkin Lymphoma

01/01/2013

Hematopoietic Stem-Cell Transplantation for Miscellaneous Solid Tumors in Adults

04/01/2013

Hematopoietic Stem-Cell Transplantation for Multiple Myeloma

01/01/2013

Hematopoietic Stem-Cell Transplantation for Non-Hodgkin Lymphomas

01/01/2013

Hematopoietic Stem-Cell Transplantation for Primary Amyloidosis or Waldenstrom Macroglobulinemia

01/01/2013

Hematopoietic Stem-Cell Transplantation for Solid Tumors of Childhood

03/01/2013

Hematopoietic Stem-Cell Transplantation in the Treatment of Germ-Cell Tumors

01/01/2013
Islet Transplantation 06/01/2013
Isolated Small Bowel Transplant 04/01/2013
Liver Transplant 06/01/2013
Pancreas Transplant 11/01/2012
Placental and Umbilical Cord Blood as a Source of Stem Cells 04/01/2013
Small Bowel/Liver and Multivisceral Transplant 06/01/2013