Stem Cell Transplantation: Non-cancer Disorders - (0535) — MM 0535 | CIGNA Coverage Update

Cigna modified MM 0535 covering hematopoietic stem cell transplantation for non-cancer disorders, effective January 16, 2026. Here's what billing teams need to know.

Cigna Healthcare updated Coverage Policy MM 0535 on January 16, 2026, addressing hematopoietic stem cell transplantation (HSCT) for non-cancerous conditions. This policy governs 16 CPT codes and three HCPCS codes — including CPT 38240 and 38241 for allogeneic and autologous HPC transplantation, CPT 38205 and 38206 for peripheral blood stem cell harvesting, and HCPCS S2142 for cord blood-derived stem cell transplantation. If your team bills HSCT for non-malignant diagnoses, this coverage policy change belongs on your radar before claims go out the door.

Quick-Reference Table

Cigna Stem Cell Transplantation Coverage Criteria and Medical Necessity Requirements 2026

The Cigna stem cell transplantation coverage policy under MM 0535 covers HSCT for select non-cancerous disorders — but only when specific medical necessity criteria are met. Every code in this policy sits in the same coverage group: "Considered Medically Necessary when criteria in the applicable section are met." That phrase is doing a lot of heavy lifting.

What that means for your billing team: the procedure code alone won't get you paid. Cigna wants documentation that the patient's condition, clinical history, and treatment pathway align with the criteria MM 0535 spells out for that specific disorder. Submitting CPT 38240 (allogeneic transplantation) or CPT 38241 (autologous transplantation) without airtight supporting documentation is a fast path to a claim denial.

Prior authorization is standard for HSCT services at Cigna, and this policy reinforces that expectation. Get the prior auth in place before harvesting, preparation, or transplantation procedures are performed. That means CPT codes 38205 through 38215, 38230, 38232, 38240, 38241, and 38242 — along with HCPCS S2140, S2142, and S2150 — all need to flow through your prior authorization process with documentation matching the updated criteria.

The real issue here is that "non-cancer disorders" is a wide net. HSCT gets used across a range of serious non-malignant conditions — severe aplastic anemia, sickle cell disease, thalassemia, primary immunodeficiencies, autoimmune diseases, and inherited metabolic disorders, among others. Each condition may have its own coverage threshold under MM 0535. Billing staff need to understand which indication is being treated, not just which procedure is being performed.

Reimbursement on HSCT claims is significant. These are high-dollar cases. A missed criterion or a documentation gap can result in a large denial — and in some cases, recoupment on cases already paid. Talk to your compliance officer if you're uncertain how the updated criteria map to your patient population.

Cigna Stem Cell Transplantation Exclusions and Non-Covered Indications

The policy data Cigna published for MM 0535 does not enumerate specific exclusions in the code-level summaries provided here. However, the structure of the policy is clear: coverage is conditional. Any indication that does not meet the criteria defined in the applicable section of MM 0535 is not covered.

That matters more than it sounds. If your team bills CPT 38241 (autologous transplantation) for a condition Cigna considers experimental or investigational under this policy, you're looking at a denial — possibly with a not-medically-necessary or experimental designation. The distinction between "criteria met" and "criteria not met" is the difference between reimbursement and a write-off on a six-figure claim.

Watch for conditions where the evidence base is evolving. Cigna reviews HSCT indications based on published clinical evidence. If a physician is recommending HSCT for a condition that's still in the clinical trial phase, verify whether Cigna's MM 0535 criteria cover it. If they don't, you need that conversation before the procedure, not after the claim drops.

Coverage Indications at a Glance

The policy summary for MM 0535 does not break out individual covered indications in the code-level data available. The following table reflects the coverage framework as documented:

For the full indication-specific criteria — which define exactly which conditions qualify for each procedure type — access the complete policy text at the Cigna MM 0535 source document. Billing teams working with HSCT volumes should pull the full policy and map each active case to the relevant criteria section.

Cigna Stem Cell Transplantation Billing Guidelines and Action Items 2026

CPT, HCPCS, and ICD-10 Codes for Stem Cell Transplantation Under MM 0535

Covered CPT Codes (When Medical Necessity Criteria Are Met)

Covered HCPCS Codes (When Medical Necessity Criteria Are Met)

Note on ICD-10 codes: The MM 0535 policy data does not enumerate specific ICD-10-CM diagnosis codes. Your team should map the patient's non-cancer disorder diagnosis to the appropriate ICD-10 code and verify it aligns with the indication-level criteria in the full MM 0535 policy text. Use the most specific diagnosis code available — unspecified codes increase denial risk on high-dollar HSCT claims.