HIGHMARK COMMERCIAL MEDICAL POLICY - PENNSYLVANIA

 
 

Medical Policy:
Z-46-011
Topic:
Blood and Bone Marrow Storage
Section:
Miscellaneous
Effective Date:
September 5, 2011
Issued Date:
February 11, 2019
Last Revision Date:
January 2019
Annual Review:
January 2019
 
 

Blood and bone marrow storage include the processing and cryopreservation of blood and bone marrow for future use.

Policy Position Coverage is subject to the specific terms of the member's benefit plan.

Blood and bone marrow storage are non-covered except for those groups/programs identified in benefits.

Indications for blood and bone marrow storage are as follows:

  • Presurgical storage of blood - Patients scheduled for surgery may donate their own blood for storage.
  • Bone marrow, peripheral blood, and umbilical cord blood storage - Bone marrow, peripheral blood, and umbilical cord blood may be donated and stored for an impending transplant.
  • Prophylactic blood and bone marrow storage - Blood or bone marrow is stored in the event of an accident or surgery requiring a transfusion, or if a transplant is needed in the future. No surgery or transplant is scheduled or planned.

Charges for presurgical storage of blood are eligible for payment if prescribed by a physician and surgery is scheduled. Blood may be donated no more than 35 days prior to the surgery. The patient should contact the Special Donations office at the blood bank.

Charges for preparation of hematopoietic progenitor cells for bone marrow, peripheral stem cell, and umbilical cord transplant (e.g., cryopreservation, storage, thawing, T-cell depletion, etc.) are generally a facility charge which should be processed in accordance with the member's benefits.

Charges for prophylactic blood storage in the event of an accident or unforeseen surgery are not eligible for payment. Blood can only be thawed 24 hours prior to use. Therefore, in the event of an emergency, the blood may not be accessible. Charges for prophylactic storage of bone marrow and stem cells are not eligible for payment and should be denied on the basis that the bone marrow and stem cells are stored without an established diagnosis for potential use. 

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This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical or other circumstances may warrant individual consideration, based on review of applicable medical records, as well as other regulatory, contractual and/or legal requirements.

Medical policies do not constitute medical advice, nor are they intended to govern the practice of medicine. They are intended to reflect Highmark's reimbursement and coverage guidelines. Coverage for services may vary for individual members, based on the terms of the benefit contract.

Highmark retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of Highmark. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.

Discrimination is Against the Law
The Claims Administrator/Insurer complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. The Claims Administrator/Insurer does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. The Claims Administrator/ Insurer:

  • Provides free aids and services to people with disabilities to communicate effectively with us, such as:
  • Qualified sign language interpreters
  • Written information in other formats (large print, audio, accessible electronic formats, other formats)

  • Provides free language services to people whose primary language is not English, such as:
  • Qualified interpreters
  • Information written in other languages
  • If you need these services, contact the Civil Rights Coordinator.

    If you believe that the Claims Administrator/Insurer has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Civil Rights Coordinator, P.O. Box 22492, Pittsburgh, PA 15222, Phone: 1-866-286-8295, TTY: 711, Fax: 412-544-2475, email: CivilRightsCoordinator@highmarkhealth.org. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Civil Rights Coordinator is available to help you.

    You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

    U.S. Department of Health and Human Services
    200 Independence Avenue, SW
    Room 509F, HHH Building
    Washington, D.C. 20201
    1-800-368-1019, 800-537-7697 (TDD)

    Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

    Insurance or benefit/claims administration may be provided by Highmark, Highmark Choice Company, Highmark Coverage Advantage, Highmark Health Insurance Company, First Priority Life Insurance Company, First Priority Health, Highmark Benefits Group, Highmark Select Resources, Highmark Senior Solutions Company or Highmark Senior Health Company, all of which are independent licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.