Aetna modified CPB 0190 governing hematopoietic cell transplant stem cell coverage, effective September 26, 2025. Here's what billing teams need to do.
Aetna, a CVS Health company, updated its stem cell transplant coverage policy under CPB 0190 in the Aetna system, adding omidubicel-onlv (Omisirge) as a covered indication and clarifying donor compatibility testing criteria. The policy covers 26 CPT codes and three HCPCS codes — including CPT 38204 through 38243 for harvesting, preparation, and transplantation, plus S2140, S2142, and S2150 for cord blood procedures. If your practice or facility bills allogeneic stem cell transplants for Aetna members, this change warrants a close read before September 26, 2025.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Stem Cells for Hematopoietic Cell Transplant |
| Policy Code | CPB 0190 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | High |
| Specialties Affected | Hematology/Oncology, Transplant Surgery, Bone Marrow Transplant Programs, Obstetrics (cord blood), Clinical Laboratory |
| Key Action | Add Omisirge (omidubicel-onlv) to your charge capture and confirm CPB 1032 cross-reference is in your prior auth workflow before September 26, 2025 |
Aetna Hematopoietic Cell Transplant Coverage Criteria and Medical Necessity Requirements 2025
The Aetna hematopoietic cell transplant coverage policy under CPB 0190 covers five distinct indications. Each has its own medical necessity criteria, and the boundaries between them matter for reimbursement.
Indication 1: Donor compatibility testing and stem cell harvesting. Aetna covers HLA typing (CPT 86813, 86817, 86821) and compatibility testing (CPT 86920–86923) for prospective donors who are first-degree relatives — parents, siblings, children — or second-degree relatives, including grandparents, grandchildren, uncles, aunts, nephews, nieces, and half-siblings. Coverage also includes harvesting and short-term storage of peripheral stem cells or bone marrow via CPT 38205 and 38230. The key phrase here is "when an allogeneic transplant is authorized by Aetna." Compatibility testing without an authorized transplant in place won't clear prior authorization.
Indication 2: Umbilical cord blood as an allogeneic transplant source. Aetna accepts cord blood stem cells (HCPCS S2140, S2142) as a medically necessary alternative to conventional bone marrow or peripheral stem cells for allogeneic transplant. This is a clean, unqualified coverage position — cord blood isn't a fallback or experimental option under this policy. Pair S2142 with CPT 38240 for allogeneic transplantation per donor when billing these cases.
Indication 3: Short-term cord blood storage for members with malignancy. This one has a critical carve-out. Aetna covers short-term storage of cord blood when a current Aetna member has a malignancy and a matching cord blood unit exists. The policy uses ICD-10 range C00.0–C75.9 (malignant neoplasm) to anchor medical necessity. Storage without an active malignancy diagnosis and a confirmed match doesn't qualify. More on what's excluded below.
Indication 4: Stem cell boosting after graft failure. CPT 38243 (HPC boost) is covered when graft failure follows an approved allogeneic hematopoietic stem cell transplant. Diagnosis codes D89.810–D89.813 (graft-versus-host disease) and T86.5 (complications of stem cell transplant) support this indication. Document the prior allogeneic transplant clearly in your records — without that history, the boost claim looks like a standalone procedure with no covered indication.
Indication 5: Omidubicel-onlv (Omisirge). This is the new addition to CPB 0190, and it comes with a cross-reference flag. Aetna covers Omisirge when clinical criteria are met, but the medical necessity criteria live in a separate policy — CPB 1032. Your prior authorization workflow needs to pull CPB 1032, not just CPB 0190, when billing for Omisirge. If your PA team doesn't know that, denials will follow.
Aetna Stem Cell Transplant Exclusions and Non-Covered Indications
The cord blood storage exclusion is the sharpest edge in this policy. Harvesting, freezing, and storing cord blood from non-diseased persons for possible future use is explicitly not covered. Aetna's position: that's not treatment of a current disease or injury, so it falls outside the scope of medical coverage entirely.
This catches families who bank cord blood at birth "just in case." The policy is clear that storage must connect to a current member with a malignancy and a confirmed match. Billing cord blood banking for a healthy newborn under S2140 or CPT 38207 won't result in reimbursement under this policy — it will result in a claim denial.
CPT 0901T (placement of bone marrow sampling port, including the Portomar access device) is listed in the policy but flagged under "use of mesenchymal stromal cell-derived extracellular vesicles." Review that cross-reference before billing 0901T for Aetna — it's in the policy data but without a clean covered or not-covered designation separate from the specific mesenchymal cell context.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Donor compatibility testing — family members (1st/2nd degree) | Covered | CPT 86813, 86817, 86821, 86920–86923, Z52.001, Z52.3 | Requires authorized allogeneic transplant in place |
| Peripheral stem cell or bone marrow harvesting from identified donor | Covered | CPT 38205, 38230, S2150 | Short-term storage only; allogeneic transplant must be authorized |
| Umbilical cord blood as allogeneic transplant source | Covered | HCPCS S2140, S2142, CPT 38240 | Accepted alternative to bone marrow or peripheral stem cells |
| Short-term cord blood storage — member with malignancy and confirmed match | Covered | CPT 38207, ICD-10 C00.0–C75.9 | Requires active malignancy diagnosis and confirmed match |
| Cord blood banking for non-diseased persons (future use) | Not Covered | S2140, CPT 38207 | Not considered treatment of current disease; expect denial |
| Stem cell boosting after allogeneic transplant graft failure | Covered | CPT 38243, ICD-10 D89.810–D89.813, T86.5 | Prior allogeneic transplant must be documented and Aetna-approved |
| Omidubicel-onlv (Omisirge) | Covered when criteria met | See CPB 1032 | Medical necessity criteria in CPB 1032, not CPB 0190 |
Aetna Stem Cell Transplant Billing Guidelines and Action Items 2025
| # | Action Item |
|---|---|
| 1 | Add CPB 1032 to your Omisirge prior auth checklist before September 26, 2025. Aetna routes all Omisirge medical necessity determinations to CPB 1032. If your PA team submits requests citing only CPB 0190, expect delays or denials. Update your prior authorization workflow now — the effective date doesn't give you a long runway. |
| 2 | Confirm your cord blood storage claims include an active malignancy diagnosis. Before billing CPT 38207 or S2140 for storage, verify the chart documents a current malignancy (C00.0–C75.9) and a confirmed match. Claims without that diagnosis pair will fail medical necessity review. Audit any pending cord blood storage claims before September 26. |
| 3 | Use Z52.001 and Z52.3 on donor harvesting claims — and verify the donor relationship. The policy limits covered compatibility testing to first- and second-degree relatives. Document the relationship in the medical record, not just on the claim. If the donor is unrelated, this policy doesn't support coverage — that's a different pathway. |
| 4 | Pair CPT 38243 (HPC boost) with the prior transplant history and correct diagnosis codes. Claims for stem cell boosting need D89.810–D89.813 or T86.5 on the claim, plus documentation of the prior Aetna-authorized allogeneic transplant. Missing either piece gives Aetna grounds to deny on medical necessity. |
| 5 | Review the 0901T billing guidelines against the mesenchymal stromal cell context in CPB 0190. CPT 0901T appears in the policy under a specific clinical context. If your program bills 0901T for Aetna, confirm your clinical documentation matches the policy's framing before the effective date of September 26, 2025. If you're not sure how this applies to your patient mix, loop in your compliance officer before claims go out. |
| 6 | Update charge capture for the full code set — preparation codes matter. CPT 38207–38215 (cryopreservation, thawing, cell depletion procedures) all require selection criteria. Make sure your charge capture system flags these codes for medical necessity review rather than letting them pass through unchecked. Billing guidelines require that criteria be met — not just that the procedure occurred. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Stem Cell Transplant Under CPB 0190
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Description |
|---|---|
| 38204 | Management of recipient hematopoietic progenitor cell donor search and cell acquisition |
| 38205 | Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; allogeneic |
| 38206 | Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; autologous |
| 38207 | Transplant preparation of hematopoietic progenitor cells; cryopreservation and storage |
| 38208 | Thawing of previously frozen harvest, without washing |
| 38209 | Thawing of previously frozen harvest, with washing |
| 38210 | Specific cell depletion within harvest, T-cell depletion |
| 38211 | Tumor cell depletion |
| 38212 | Red blood cell removal |
| 38213 | Platelet depletion |
| 38214 | Plasma (volume) depletion |
| 38215 | Cell concentration in plasma, mononuclear |
| 38230 | Bone marrow harvesting for transplantation |
| 38240 | Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor |
| 38243 | Hematopoietic progenitor cell (HPC); HPC boost |
| 59012 | Cordocentesis (intrauterine), any method |
| 86813 | HLA typing; A, B, or C, multiple antigens |
| 86817 | HLA typing; DR/DQ, multiple antigens |
| 86821 | HLA typing; lymphocyte culture, mixed (MLC) |
| 86920 | Compatibility test each unit; immediate spin technique |
| 86921 | Compatibility test each unit; incubation technique |
| 86922 | Compatibility test each unit; antiglobulin technique |
| 86923 | Compatibility test each unit; electronic |
Other CPT Codes Related to CPB 0190
| Code | Description | Notes |
|---|---|---|
| 38221 | Diagnostic bone marrow; biopsy(ies) | Related code — not in primary covered group |
| 38222 | Diagnostic bone marrow; biopsy(ies) | Related code — not in primary covered group |
| 0901T | Placement of bone marrow sampling port, including imaging guidance when performed (Portomar access) | Listed under mesenchymal stromal cell-derived extracellular vesicle context — confirm clinical alignment before billing |
Covered HCPCS Codes (When Selection Criteria Are Met)
| Code | Description |
|---|---|
| S2140 | Cord blood harvesting for transplantation, allogeneic |
| S2142 | Cord blood-derived stem-cell transplantation, allogeneic |
| S2150 | Bone marrow or blood-derived stem cells (peripheral or umbilical), allogeneic or autologous, harvesting |
Key ICD-10-CM Diagnosis Codes
| Code | Description |
|---|---|
| C00.0–C75.9 | Malignant neoplasm (range) |
| D89.810 | Acute graft-versus-host disease |
| D89.811 | Chronic graft-versus-host disease |
| D89.812 | Acute on chronic graft-versus-host disease |
| D89.813 | Graft-versus-host disease, unspecified |
| T86.5 | Complications of stem cell transplant |
| Z52.001 | Unspecified donor, stem cells |
| Z52.3 | Bone marrow donor |
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