Or. Admin. R. 410-124-0090 - Criteria and Contraindications for Harvesting Autologous Bone Marrow and Peripheral Stem Cells

Current through Register Vol. 60, No. 12, December 1, 2021

(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 center 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 Division of Medical Assistance Programs (Division) will prior authorize and 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 center's and the specialist's evaluations recommend that the transplant be authorized; 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 410-141-0520; 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 410-141-0520; 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) Prior authorization for 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, and the transplant must be prior authorized by the Division before reimbursement will be approved.

Notes

Or. Admin. R. 410-124-0090
OMAP 34-2001, f. 9-24-01, cert. ef. 10-1-01; OMAP 49-2002, f. & cert. ef. 10-1-02; DMAP 51-2015, f. 9-22-15, cert. ef. 10-1-15

Stat. Auth.: ORS 413.042

Stats. Implemented: ORS 414.065

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