CMS revises coverage criteria for autologous transplant in multiple myeloma

What changed

CMS posted its final reconsideration of the multiple-myeloma provision of national coverage determination 110.23 on October 28, 2026, and states that the revised criteria are effective that day. The decision covers a single autologous stem-cell transplant when the patient has active multiple myeloma under the specified International Myeloma Working Group definition and meets an accepted staging requirement. Active disease requires at least 10% monoclonal bone marrow plasma cells or a biopsy-proven bony or extramedullary plasmacytoma, together with at least one SLiM/CRAB myeloma-defining event.

The staging requirement permits any stage under the International Staging System or its revisions, or stage II or III under the Durie-Salmon system. CMS framed reconsideration around prognostic staging tools and outcomes after autologous transplantation. The decision does not cover every transplant or every myeloma diagnosis automatically. Its appendix separately identifies tandem autologous transplantation for multiple myeloma among nationally non-covered indications. Earlier NCD language and claim-processing instructions require further comparison.

Why it matters

Transplant, oncology, utilization review and revenue-cycle teams may need to align coverage documentation with the revised national language. A staging label alone does not satisfy every criterion; individual clinical suitability and other applicable conditions remain separate questions.

Suggested action

Suggested internal action: clinical and coverage owners should compare the new NCD language with transplant authorization and documentation workflows, identify affected cases and staging evidence, and check CMS and Medicare Administrative Contractor implementation instructions before changing billing or authorization procedures. No new CMS deadline for these planning steps is asserted.

Sources

• Autologous Stem Cell Transplantation for Multiple Myeloma (CAG-00444R2), Decision Memo, Centers for Medicare & Medicaid Services; source date 2026-10-28.