Or. Admin. Code § 410-124-0091 - [Effective until 1/13/2025] Criteria and Contraindications for Harvesting Autologous Bone Marrow and Peripheral Stem Cells
(1) The following
are contraindications for the harvesting and storage of autologous bone marrow
or peripheral stem cells for a potential transplant. The potential transplant
recipient has:
(a) Irreversible terminal
state (moribund or on life support);
(b) An irreversible disease of any other
major organ system likely to limit life expectancy to five (5) years or
less;
(c) Positive HIV test
results;
(d) Positive pregnancy
test.
(2) The following
may be considered contraindications for the harvesting and storage of
autologous bone marrow or peripheral stem cells for a transplant to the extent
the evaluating transplant hospital and/or the specialist who completed the
comprehensive evaluation of the client believe these condition(s) may interfere
significantly with the recovery process. The potential transplant recipient
has:
(a) Serious psychological
disorders;
(b) Alcohol or drug
abuse.
(3) The Health
Systems Division (Division) shall reimburse for the harvesting and storage of
autologous bone marrow or autologous peripheral stem cells for a potential
transplant recipient only if:
(a) All Division
criteria are met; and
(b) Both the
transplant hospital's and the specialist's evaluations recommend the
transplant; and
(c) The ICD-10-CM
diagnosis code(s) and the CPT bone marrow or peripheral stem cell harvesting
for transplantation procedure code(s) are paired on a currently funded line on
the Prioritized List of Health Services adopted under OAR
410-141-3830; and
(d) There is documentation of a morphology
code listed on the currently funded line for pediatric solid tumor in the
Prioritized List of Health Services adopted under OAR
410-141-3830; and
(e) The client's marrow meets the clinical
standards of remission at the time of storage; and
(f) A board certified hematologist/oncologist
with specific experience in bone marrow transplant (BMT) services (i.e.,
cryopreservation and immunosuppressive treatment) has recommended the storage
of autologous bone marrow or peripheral stem cell collection for possible
future transplant/reinfusion; and
(g) The client has no contraindications for
the harvesting and storage of autologous bone marrow or peripheral stem cells;
and
(h) The client has no
contraindications for bone marrow transplant or peripheral stem cell
transplant.
(4)
Harvesting of autologous bone marrow or peripheral stem cells does not
guarantee reimbursement for the transplant. The client must meet the criteria
specified in this rule and OAR
410-124-0080, at the time the
transplant is performed.
Notes
Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: 414.065
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