Hematopoietic Cell Transplantation for Inherited Metabolic Disorders and Genetic Diseases — CPB 0871 | AETNA Coverage Update

Aetna modified CPB 0871 covering hematopoietic cell transplantation (HCT) for inherited metabolic disorders and genetic diseases, effective January 5, 2026. Here's what billing teams need to know.

Aetna, a CVS Health company, updated this coverage policy to clarify which conditions qualify for allogeneic HCT and which procedures remain experimental or non-covered. The policy governs CPT codes 38204 through 38243 and HCPCS codes S2142 and S2150. If your team bills transplant preparation, harvesting, or infusion codes for diagnoses like Hurler's syndrome (E76.1), Krabbe disease (E75.23), or metachromatic leukodystrophy (E75.25), this update affects your claims.

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Quick-Reference Table

Field	Detail Copy
Payer	Aetna, a CVS Health company
Policy	Hematopoietic Cell Transplantation for Inherited Metabolic Disorders and Genetic Diseases
Policy Code	CPB 0871 Aetna
Change Type	Modified
Effective Date	January 5, 2026
Impact Level	High — transplant programs and pediatric specialty centers
Specialties Affected	Hematology/oncology, pediatric subspecialties, transplant programs, metabolic disease centers
Key Action	Audit active prior authorization requests and charge capture for allogeneic vs. autologous transplant codes before billing against this policy

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Aetna HCT Coverage Criteria and Medical Necessity Requirements 2026

The Aetna HCT coverage policy under CPB 0871 draws a hard line between allogeneic and autologous transplant. Allogeneic HCT is covered for a defined list of inherited metabolic disorders. Autologous HCT is not covered for any of the indications in this policy. That distinction drives most of the claim denial risk here.

To meet medical necessity under CPB 0871, allogeneic HCT must be used for one of these confirmed diagnoses:

Each of these has specific ICD-10-CM codes. Map them correctly. Billing 38240 (allogeneic HPC transplantation per donor) against the wrong diagnosis code will trigger a denial even when the clinical case is solid.

Fanconi anemia has its own criteria. Allogeneic HCT is medically necessary for children and adolescents with Fanconi anemia who meet any one of the following: they have failed supportive care, androgens, and hematopoietic growth factors; they cannot tolerate those approaches; or they have developed severe bone marrow failure, myelodysplasia, or acute myeloid leukemia. Documentation of any one of these pathways is sufficient — you don't need all three.

Infantile malignant osteopetrosis also has specific criteria. Allogeneic HCT is covered when the diagnosis is confirmed by both bone biopsy and radiographic imaging, and when the patient does not show irreversible neurologic impairment or multi-organ failure. Miss either of those documentation elements and you're exposed on prior auth.

CPB 0871 does not state specific prior authorization requirements. Contact Aetna directly to confirm PA requirements for your specific plan and member contract.

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Aetna HCT Exclusions and Non-Covered Indications

Aetna's experimental and non-covered list under this coverage policy is worth reading carefully. These are the claims most likely to get denied — and some of the diagnoses may look clinically similar to covered ones.

Barakat syndrome (HDR syndrome): Aetna classifies allogeneic HCT for this condition as experimental. The source policy does not address autologous HCT for Barakat syndrome separately.

Autologous HCT: Codes 38206 (autologous blood-derived harvesting), 38232 (autologous bone marrow harvesting), and 38241 (autologous HPC transplantation) are not covered for any indication listed in CPB 0871. If you're billing autologous transplant codes for mucopolysaccharidosis or childhood-onset adrenoleukodystrophy, expect a denial.

HCT — autologous, allogeneic, or cord blood — for these conditions is experimental:

#	Excluded Procedure Copy
1	Hereditary corneal defects (see full policy for complete ICD-10 code list)
2	Huntington's disease (G10)
3	TRNT1 enzyme deficiency (E88.09)

The Huntington's disease exclusion catches people off guard. The ICD-10 code G10 shows up in this policy's code set, but it's listed as a non-covered indication. If a patient has G10 and a team requests HCT, the claim dies on arrival under this policy.

The TRNT1 exclusion is newer and worth flagging. This is a rare mitochondrial disorder, and some centers have been exploring HCT as a treatment. Aetna is not covering it under CPB 0871.

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Coverage Indications at a Glance

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Aetna HCT Billing Guidelines and Action Items 2026

The effective date for this updated policy is January 5, 2026. Review open claims and active prior authorizations before submitting new requests.

Copy Action Items

If you treat a high volume of these rare diagnoses and you're not sure how this policy intersects with your payer mix, loop in your compliance officer before the January 5, 2026 effective date passes without a review.

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CPT, HCPCS, and ICD-10 Codes for HCT Under CPB 0871

Covered CPT Codes (When Selection Criteria Are Met)

Not Covered / Experimental Codes

Code	Type	Description	Reason Copy
38206	CPT	Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; autologous	Not covered for indications listed in CPB 0871
38232	CPT	Bone marrow harvesting for transplantation; autologous	Not covered for indications listed in CPB 0871
38241	CPT	Hematopoietic progenitor cell (HPC); autologous transplantation	Not covered for indications listed in CPB 0871

Key ICD-10-CM Diagnosis Codes

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