`S2142` Cord blood-derived stem-cell

Cord blood-derived stem-cell transplantation, allogeneic

Medicare coverage: Not payable by Medicare
Status: active (October 2026 file)

Medicare pricing for S2142

Physician Fee Schedule (CY 2026, RVU26D)

Status I: not valid for Medicare (Medicare uses another code).

Payer policies and prior authorization for S2142

39 of 40 payer prior-auth lists that name S2142 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Texas, Cigna, Humana, Molina Complete Care (Virginia), Molina Healthcare of California, Molina Healthcare of Idaho, Molina Healthcare of Illinois, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, Molina Healthcare of Nevada, Molina Healthcare of New Mexico, Molina Healthcare of Ohio, Molina Healthcare of Texas, Molina Healthcare of Utah, Neighborhood Health Partnership, Oxford Health Plans, Passport by Molina Healthcare (Kentucky), Rocky Mountain Health Plans, and others.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Blue Cross Blue Shield of Arizona (AZ Blue)	Federal Employee Program (FEP)	AZ	prior auth required		Sep 1, 2026	Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026)
Blue Cross Blue Shield of Arizona (AZ Blue)	Standard PA code list (most commercial plans)	AZ	prior auth required		Sep 1, 2026	AZ Blue Standard Prior Authorization Requirements Code List (09/01/2026)
Blue Cross Blue Shield of Arizona (AZ Blue)	State of Arizona employee group (SYD, S3Z)	AZ	prior auth required		Sep 1, 2026	State of Arizona Group Prior Authorization Requirements Code List (09/01/2026)
Blue Cross Blue Shield of Arizona (AZ Blue)	Teamsters group (TYW)	AZ	prior auth required		Sep 1, 2026	Teamsters Group Prior Authorization Requirements Code List (Updated 09/01/2026)
Cigna	ACA/IFP	All	prior auth required		Jan 1, 2001	Master Precertification List (For Health Care Providers)
Cigna	Basic Standard	All	prior auth required		Jan 1, 2001	Master Precertification List (For Health Care Providers)
Cigna	Complete/PHS+/Preferred	All	prior auth required		Jan 1, 2001	Master Precertification List (For Health Care Providers)
Blue Cross and Blue Shield of Texas	Texas PA exemption (gold card), outpatient, fully insured	TX	prior auth required	Gold-card exemption available	Jul 1, 2026	BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range)
Humana	Humana Healthy Horizons	FL	prior auth required		Jan 1, 2027	1102002FL1026 FLHN8CBEN Humana Healthy Horizons in Florida Preauthorization and Notification List
Humana	Humana Healthy Horizons	KY	prior auth required		Jan 1, 2027	please visit Humana Healthy Horizons in Kentucky Clinical coverage policies.
Humana	Humana Healthy Horizons	LA	prior auth required		Jan 1, 2027	Humana Healthy Horizons in Louisiana Prior Authorization and Notification List To Except where noted via links on the following pages, prior authorization requests for medical services may be initiate
Humana	Humana Healthy Horizons	SC	prior auth required		Jan 1, 2027	Humana Healthy Horizons in South Carolina Prior authorization and Notification List The following list describes services and medications that are commonly reviewed and may require additional clinical
Molina Complete Care (Virginia)	Medicaid	VA	prior auth required		Apr 1, 2025	Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025
Molina Healthcare of California	Medicaid	CA	prior auth required		Apr 1, 2026	Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026
Molina Healthcare of Idaho	Medicaid	ID	prior auth required		Jan 1, 2025	Idaho Medicaid Prior Auth (PA) Code Matrix and Idaho code/benefit exceptions, Q1 2025
Molina Healthcare of Illinois	Medicaid	IL	prior auth required		Jan 1, 2022	Molina Healthcare of Illinois Codification Grid Q3 2026
Molina Healthcare of Iowa	Medicaid	IA	prior auth required		Jul 1, 2023	IA Prior Authorization Matrix, effective Q3 2023
Molina Healthcare of Michigan	Medicaid	MI	prior auth required		Jul 1, 2026	Molina Healthcare of Michigan PA Matrix 2026-Q3
Molina Healthcare of Michigan	Exchange	MI	prior auth required		Jul 1, 2021	Molina Healthcare of Michigan PA Matrix, effective 7/1/2021
Molina Healthcare of Mississippi	Medicaid	MS	prior auth required		Jan 1, 2025	Mississippi Medicaid Prior Auth (PA) Code Matrix and exceptions, effective Q1 2025
Molina Healthcare of Nevada	Medicaid	NV	prior auth required		Oct 1, 2022	Medicaid Prior Auth (PA) Code Matrix, effective Q4 2022
Molina Healthcare of New Mexico	Medicaid	NM	prior auth required		Jul 1, 2026	New Mexico Medicaid Prior Auth (PA) Code Matrix, effective July 1, 2026
Molina Healthcare of Ohio	Medicaid and MyCare Ohio (MMP) Medicaid	OH	prior auth required		Oct 1, 2023	Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of Ohio	Exchange	OH	prior auth required		Oct 1, 2023	Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of Texas	STAR	TX	prior auth required		Feb 19, 2025	Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR), reviewed 2025-02-19
Molina Healthcare of Texas	STAR+PLUS	TX	prior auth required		Feb 19, 2025	Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR+PLUS), reviewed 2025-02-19
Molina Healthcare of Texas	STAR, STAR+PLUS, STAR Kids, CHIP (Medicaid PA code matrix)	TX	prior auth required		Jul 1, 2026	Medicaid Behavioral Health and Medical Prior Authorization (PA) Code Matrix (Texas), 2026-Q3
Molina Healthcare of Utah	Medicaid	UT	prior auth required		Jan 1, 2025	Utah Medicaid Prior Auth (PA) Code Matrix and Utah code/benefit exceptions, Q1 2025
Passport by Molina Healthcare (Kentucky)	Medicaid	KY	prior auth required		Jul 1, 2026	Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026
Neighborhood Health Partnership	Neighborhood Health Partnership	FL	prior auth required		Sep 1, 2026	Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026
Oxford Health Plans	Oxford Health Plans	All	prior auth required		Oct 1, 2026	Prior Authorization Requirements for Oxford Effective October 1, 2026
Rocky Mountain Health Plans	Rocky Mountain Health Plans Prime / RAE	CO	prior auth required		Oct 1, 2026	Rocky Mountain Health Plans PRIME Effective October 1, 2026
Surest	Surest health plans	All	prior auth required		Oct 1, 2026	Prior Authorization Requirements for Surest Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare Commercial	All	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare commercial plans Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare Individual Exchange plans	All	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare Mid-Atlantic Health Plans	All	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Mid-Atlantic Health Plans Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare West commercial plans	All	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare West commercial plans Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare of the River Valley	All	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare of the River Valley Effective October 1, 2026
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of Kentucky	KY	prior auth required		Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026

Payer coverage policies that name S2142

S2142 appears in 103 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, Blue Shield of California, BlueCross BlueShield of South Carolina, Capital Blue Cross, Centene, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Afamitresgene Autoleucel (Tecelra) (1068)	listed, no stance	Jan 14, 2026	payer document
Aetna	Bone and Tendon Graft Substitutes and Adjuncts (0411)	not covered	Aug 18, 2026	payer document
Aetna	Epilepsy Surgery (0394)	not covered	Jun 23, 2026	payer document
Aetna	Erythropoiesis Stimulating Agents (0195)	not covered	Jan 20, 2026	payer document
Aetna	Hematopoietic Cell Transplantation for Autoimmune Diseases and Miscellaneous Indications (0606)	not covered	Sep 18, 2026	payer document
Aetna	Hematopoietic Cell Transplantation for Inherited Metabolic Disorders and Genetic Diseases (0871)	covered if criteria are met	Dec 22, 2025	payer document
Aetna	Hematopoietic Cell Transplantation for Solid Tumors in Adults (0811)	not covered	Dec 3, 2025	payer document
Aetna	Intradiscal Procedures (0602)	not covered	Sep 2, 2026	payer document
Aetna	Narsoplimab-wuug (Yartemlea) (1099)	listed, no stance	Apr 27, 2026	payer document
Aetna	Omidubicel-onlv (Omisirge) (1032)	listed, no stance	Apr 27, 2026	payer document
Aetna	Pegzilarginase-nbln (Loargys) (1101)	listed, no stance	Jun 26, 2026	payer document
Aetna	Stem Cells for Hematopoietic Cell Transplant (0190)	covered if criteria are met	Mar 27, 2026	payer document
Anthem	Hematopoietic Stem Cell Transplantation for Autoimmune Disease and Miscellaneous Solid Tumors (TRANS.00031)	unproven / investigational	May 14, 2026	payer document
Anthem	Hematopoietic Stem Cell Transplantation for Diabetes Mellitus (TRANS.00034)	unproven / investigational	Nov 6, 2025	payer document
Anthem	Hematopoietic Stem Cell Transplantation for Genetic Diseases and Aplastic Anemias (TRANS.00029)	covered if criteria are met	Nov 6, 2025	payer document
Anthem	Hematopoietic Stem Cell Transplantation for Germ Cell Tumors (TRANS.00030)	unproven / investigational	Nov 6, 2025	payer document
Anthem	Hematopoietic Stem Cell Transplantation for Hodgkin Disease and non-Hodgkin Lymphoma (TRANS.00028)	covered if criteria are met	May 14, 2026	payer document
Anthem	Hematopoietic Stem Cell Transplantation for Multiple Myeloma and Other Plasma Cell Dyscrasias (TRANS.00023)	covered if criteria are met	Nov 6, 2025	payer document
Anthem	Hematopoietic Stem Cell Transplantation for Pediatric Solid Tumors (TRANS.00027)	covered if criteria are met	Nov 6, 2025	payer document
Anthem	Hematopoietic Stem Cell Transplantation for Select Leukemias and Myelodysplastic Syndrome (TRANS.00024)	covered if criteria are met	Nov 6, 2025	payer document
Blue Cross & Blue Shield of Mississippi	Hematopoietic Cell Transplantation For Acute Lymphoblastic Leukemia To report antineoplastic drugs, see code range J9000 - J9999 in the HCPCS Level II manual.	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Hematopoietic Cell Transplantation For Acute Myeloid Leukemia To report antineoplastic drugs, see code range J9000-J9999 in the HCPCS Level II manual.	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Hematopoietic Cell Transplantation For Chronic Lymphocytic Leukemiasmall Lymphocytic Lymphoma HCPCS - To report antineoplastic drugs, see code range J9000-J9999 in the HCPCS Level II manual.	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Hematopoietic Cell Transplantation For Chronic Myeloid Leukemia	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Hematopoietic Cell Transplantation For Cns Embryonal Tumors And Ependymoma	unproven / investigational		payer document
Blue Cross & Blue Shield of Mississippi	Hematopoietic Cell Transplantation For Epithelial Ovarian Cancer To report antineoplastic drugs, see code range J9000-J9999 in the HCPCS Level II manual.	unproven / investigational		payer document
Blue Cross & Blue Shield of Mississippi	Hematopoietic Cell Transplantation For Miscellaneous Solid Tumors In Adults To report antineoplastic drugs, see code range J9000-J9999 in the HCPCS Level II manual.	unproven / investigational		payer document
Blue Cross & Blue Shield of Mississippi	Hematopoietic Cell Transplantation In The Treatment Of Germ Cell Tumors	unproven / investigational		payer document
Blue Cross & Blue Shield of Mississippi	Nonmyeloablative Allogeneic Transplants Of Hematopoietic Stemcells For Treatment Of Malignancy (L.8.01.406) To report antineoplastic drugs, see code range J9000-J9999 in the HCPCS Level II manual	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Placental And Umbilical Cord Blood As A Source Of Stem Cells (L.7.01.442)	covered if criteria are met		payer document
Blue Cross Blue Shield of Massachusetts	Allogeneic Hematopoietic Stem Cell Transplantation for Genetic Disease and Acquired Anemias (190)	listed, no stance		payer document
Blue Cross Blue Shield of Massachusetts	Hematopoietic Cell Transplantation (076)	listed, no stance		payer document
Blue Cross Blue Shield of Massachusetts	Hematopoietic Cell Transplantation for Acute Myeloid Leukemia (150)	listed, no stance		payer document
Blue Cross Blue Shield of Massachusetts	Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma (074)	listed, no stance		payer document
Blue Cross Blue Shield of Massachusetts	Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia (212)	listed, no stance		payer document
Blue Cross Blue Shield of Massachusetts	Hematopoietic Cell Transplantation for Hodkin Lymphoma (207)	listed, no stance		payer document
Blue Cross Blue Shield of Massachusetts	Hematopoietic Cell Transplantation for Multiple Myeloma (075)	unproven / investigational		payer document
Blue Cross Blue Shield of Massachusetts	Hematopoietic Cell Transplantation for Non-Hodgkin Lymphomas (143)	listed, no stance		payer document
Blue Cross Blue Shield of Massachusetts	Hematopoietic Cell Transplantation for Solid Tumors of Childhood (208)	unproven / investigational		payer document
Blue Cross Blue Shield of Massachusetts	Hematopoietic Cell Transplantation fr Epithelial Ovarian Cancer (204)	unproven / investigational		payer document
Blue Cross Blue Shield of Massachusetts	Hematopoietic Cell Transplantation in the Treatment of Germ Cell Tumors (247)	unproven / investigational		payer document
Blue Cross Blue Shield of Massachusetts	Hematopoietic Stem-Cell Transplantation for Waldenstrom Macroglobulinemia (322)	unproven / investigational		payer document
Blue Cross Blue Shield of Massachusetts	hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults (191)	unproven / investigational		payer document
Blue Shield of California	Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia (8.01.32)	listed, no stance		payer document
Blue Shield of California	Hematopoietic Cell Transplantation for Acute Myeloid Leukemia (8.01.26)	listed, no stance		payer document
Blue Shield of California	Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (8.01.15)	listed, no stance		payer document
Blue Shield of California	Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia (8.01.30)	listed, no stance		payer document
Blue Shield of California	Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer (8.01.23)	listed, no stance		payer document
Blue Shield of California	Hematopoietic Cell Transplantation for Hodgkin Lymphoma (8.01.29)	listed, no stance		payer document
Blue Shield of California	Hematopoietic Cell Transplantation for Non-Hodgkin Lymphomas (8.01.20)	listed, no stance		payer document
Blue Shield of California	Hematopoietic Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome (8.01.17)	listed, no stance		payer document
Blue Shield of California	Hematopoietic Cell Transplantation for Primary Amyloidosis (8.01.42)	listed, no stance		payer document
Blue Shield of California	Hematopoietic Cell Transplantation for Solid Tumors of Childhood (8.01.34)	listed, no stance		payer document
Blue Shield of California	Hematopoietic Cell Transplantation in the Treatment of Germ Cell Tumors (8.01.35)	listed, no stance		payer document
BlueCross BlueShield of South Carolina	Hematopoietic Cell Transplantation for Breast Cancer (CAM 80127)	listed, no stance	Jul 1, 2026	payer document
BlueCross BlueShield of South Carolina	Hematopoietic Stem-Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome (CAM 80117)	listed, no stance	Jan 1, 2026	payer document
Capital Blue Cross	Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia (MP 9.041) Procedure codes	covered if criteria are met	Sep 1, 2026	payer document
Capital Blue Cross	Hematopoietic Cell Transplantation for Acute Myeloid Leukemia (MP 9.040) Procedure codes	covered if criteria are met	May 1, 2026	payer document
Capital Blue Cross	Hematopoietic Cell Transplantation for Autoimmune diseases (MP 9.053) Procedure codes	unproven / investigational	Sep 1, 2026	payer document
Capital Blue Cross	Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma (MP 9.038) Procedure codes	covered if criteria are met	Sep 1, 2026	payer document
Capital Blue Cross	Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia (MP 9.039) Procedure codes	covered if criteria are met	Sep 1, 2026	payer document
Capital Blue Cross	Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer (MP 9.047) Procedure codes	unproven / investigational	May 1, 2026	payer document
Capital Blue Cross	Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults (MP 9.048) Procedure codes	unproven / investigational	May 1, 2026	payer document
Capital Blue Cross	Hematopoietic Cell Transplantation for Non-Hodgkin Lymphomas (MP 9.042) Procedure Codes	covered if criteria are met	Sep 1, 2026	payer document
Capital Blue Cross	Hematopoietic Cell Transplantation for Primary Amyloidosis (MP 9.045) Procedure codes	unproven / investigational	May 1, 2026	payer document
Capital Blue Cross	Hematopoietic Cell Transplantation for Solid Tumors of Childhood (MP 9.054) Procedure Codes	unproven / investigational	Sep 1, 2026	payer document
Centene	Nonmyeloablative Allogeneic Stem Cell Transplants Reference Number: CP.MP.141 (CP.MP.141)	covered if criteria are met	Jan 1, 2026	payer document
Cigna	Stem Cell Transplantation: Blood Cancers (0533)	covered if criteria are met	Aug 15, 2026	payer document
Cigna	Stem Cell Transplantation: Non-Cancer Disorders (0535)	covered if criteria are met	Jan 15, 2026	payer document
Cigna	Stem Cell Transplantation: Solid Tumors (0534)	covered if criteria are met	Jan 15, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms (SUR703.032) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,	listed, no stance	May 15, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia (SUR703.043) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,	listed, no stance	Sep 1, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Hematopoietic Cell Transplantation for Acute Myeloid Leukemia (SUR703.037) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,	listed, no stance	Aug 15, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Hematopoietic Cell Transplantation for Autoimmune Diseases (SUR703.036) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,	listed, no stance	Jun 15, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Hematopoietic Cell Transplantation for Breast Cancer (SUR703.038) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,	listed, no stance	May 1, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Hematopoietic Cell Transplantation for Central Nervous System Embryonal Tumors and Ependymoma (SUR703.039) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,	listed, no stance	Sep 1, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL) (SUR703.029) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,	listed, no stance	May 15, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia (SUR703.041) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,	listed, no stance	Jun 15, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer (SUR703.034) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,	listed, no stance	May 1, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Hematopoietic Cell Transplantation for Genetic Diseases and Acquired Anemias (SUR703.033) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,	listed, no stance	Jun 15, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Hematopoietic Cell Transplantation for Hodgkin Lymphoma (SUR703.040) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,	listed, no stance	Apr 15, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults (SUR703.035) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,	listed, no stance	Aug 15, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Hematopoietic Cell Transplantation for Non-Hodgkin Lymphomas (SUR703.031) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,	listed, no stance	May 1, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Hematopoietic Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome (SUR703.030) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,	listed, no stance	May 1, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Hematopoietic Cell Transplantation for Primary Systemic Amyloidosis (SUR703.046) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,	listed, no stance	Jun 15, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Hematopoietic Cell Transplantation for Solid Tumors of Childhood (SUR703.044) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,	listed, no stance	Jun 15, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Hematopoietic Cell Transplantation for Waldenstrom Macroglobulinemia (SUR703.050) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,	listed, no stance	Jan 1, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Hematopoietic Cell Transplantation in the Treatment of Germ Cell Tumors (SUR703.045) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,	listed, no stance	Jun 15, 2026	payer document
Premera Blue Cross	Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms (8.01.539)	listed, no stance	Mar 23, 2026	payer document
Premera Blue Cross	Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia (8.01.520) Page \| 3 of 19 \| ∞	listed, no stance	Mar 23, 2026	payer document
Premera Blue Cross	Hematopoietic Cell Transplantation for Acute Myeloid Leukemia (8.01.542)	listed, no stance	Apr 14, 2026	payer document
Premera Blue Cross	Hematopoietic Cell Transplantation for Autoimmune Diseases (8.01.25)	listed, no stance	Jul 14, 2026	payer document
Premera Blue Cross	Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma (8.01.15)	listed, no stance	Mar 9, 2026	payer document
Premera Blue Cross	Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia (8.01.30)	listed, no stance	Mar 9, 2026	payer document
Premera Blue Cross	Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer (8.01.23)	listed, no stance	Mar 9, 2026	payer document
Premera Blue Cross	Hematopoietic Cell Transplantation for Hodgkin Lymphoma (8.01.29)	listed, no stance	Mar 23, 2026	payer document
Premera Blue Cross	Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults (8.01.24)	listed, no stance	Mar 9, 2026	payer document
Premera Blue Cross	Hematopoietic Cell Transplantation for Non-Hodgkin Lymphomas (8.01.529)	listed, no stance	Mar 9, 2026	payer document
Premera Blue Cross	Hematopoietic Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome (8.01.17)	listed, no stance	Mar 9, 2026	payer document
Premera Blue Cross	Hematopoietic Cell Transplantation for Primary Amyloidosis (8.01.42)	listed, no stance	Mar 9, 2026	payer document

Recent prior-auth changes

Jul 1, 2026: PA added, Rocky Mountain Health Plans
Apr 1, 2026: PA removed, UnitedHealthcare Community Plan
Jan 1, 2026: PA removed, Molina Healthcare of Michigan
Oct 1, 2025: PA added, UnitedHealthcare
Mar 1, 2025: PA removed, Rocky Mountain Health Plans
Mar 1, 2025: PA removed, Rocky Mountain Health Plans
Jan 1, 2025: PA removed, UnitedHealthcare
Oct 1, 2024: conditions changed, Molina Healthcare of Texas
Oct 1, 2024: conditions changed, Molina Healthcare of Texas

Medicaid fee-for-service

Prior authorization required or conditional in CO, IN.

CO: $192.32 (health_first_colorado), effective Jul 1, 2026
ND: $0.00 (physician), effective Aug 1, 2026
TX: $64.04 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2023

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

S2142 Cord blood-derived stem-cell