Does S2142 require prior authorization?

No, S2142 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

What is the Medicare reimbursement rate for S2142?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`S2142`, Cord blood-derived stem-cell transplantation, allogeneic

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

ChronOS / TCP with bone marrow studies: documentation of diagnosis (benign cystic bone lesion type: non-ossifying fibroma, enchondroma, fibrous dysplasia, aneurysmal bone cyst, juvenile bone cyst), operative records showing mixing of ChronOS granules with autologous bone marrow harvested during surgery, and radiographic follow-up using Neer classification for bone regeneration.
For antibiotic bead local therapy (calcium sulfate beads): operative notes documenting debridement and bead placement, systemic antibiotic regimen, culture results, and follow-up documentation of wound status (presence/character of wound discharge) and radiographic dissolution of beads (authors reported beads dissolved at average ~36 days).
For INFUSE lumbar fusion: documentation that 'The member meets medical necessity criteria for lumbar spinal fusion in CPB 0743 - Spinal Surgery: Laminectomy and Fusion' and that 'INFUSE Bone Graft is to be implanted via an anterior (ALIF) or lateral (OLIF, DLIF, XLIF or LLIF) approach.'
For INFUSE in tibial shaft fractures: documentation that the patient is skeletally mature; that the acute, open tibial shaft fracture has been stabilized with intramedullary nail fixation; that appropriate wound management was performed; and that INFUSE Bone Graft will be applied within 14 days after the initial fracture.
For PMMA or calcium sulfate antibiotic beads: documentation of diagnosis of chronic osteomyelitis (e.g., ICD-10 M86.30–M86.69) and documentation that beads will be used in conjunction with intravenous antibiotics.
For allograft use in spinal fusion and osteochondral defects: documentation that clinical indication meets the selection criteria for spinal fusion per CPB 0743 (reference to CPB 0743 required) or documentation of osteochondral defect requiring bone void filler.

Key Coverage Criteria

posterolateral lumbar fusion
cervical interbody fusion
fracture healing / nonunion fractures
long bone nonunion (tibial nonunions referenced)
treatment of open tibial fractures
healing nonunion fractures

20 Active Policies

ANTHEM-MP-A070096, TRANS.00034 Hematopoietic Stem Cell Transplantation for Diabetes Mellitus

ANTHEM-MP-A053844, TRANS.00031 Hematopoietic Stem Cell Transplantation for Autoimmune Disease and Miscellaneous Solid Tumors

ANTHEM-MP-A053842, TRANS.00030 Hematopoietic Stem Cell Transplantation for Germ Cell Tumors

ANTHEM-MP-A047473, TRANS.00027 Hematopoietic Stem Cell Transplantation for Pediatric Solid Tumors

ANTHEM-MP-A045963, Status

AETNA-CPB-0411, Bone and Tendon Graft Substitutes and Adjuncts

AETNA-CPB-0394, Epilepsy Surgery

AETNA-CPB-0190, Stem Cells for Hematopoietic Cell Transplant

AETNA-CPB-0602, Intradiscal Procedures

AMBETTER-CP.MP.141, Nonmyeloablative Allogeneic Stem Cell Transplants

BCBSIL-SUR703.043, Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia

BCBSIL-SUR703.037, Hematopoietic Cell Transplantation for Acute Myeloid Leukemia

BCBSIL-SUR703.038, Hematopoietic Cell Transplantation for Breast Cancer

BCBSIL-SUR703.029, Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL)

BCBSIL-SUR703.041, Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia

BCBSIL-SUR703.034, Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer

BCBSIL-SUR703.033, Hematopoietic Cell Transplantation for Genetic Diseases and Acquired Anemias

BCBSIL-SUR703.040, Hematopoietic Cell Transplantation for Hodgkin Lymphoma

BCBSIL-SUR703.035, Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults

ANTHEM-MP-A047560, TRANS.00029 Hematopoietic Stem Cell Transplantation for Genetic Diseases and Aplastic Anemias

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S2142, Cord blood-derived stem-cell transplantation, allogeneic