Transmittal R14035CP (CR 14645): claims coding for expanded NCD 110.23 coverage of allogeneic stem cell transplant for MDS
Published November 8, 2026 · Coverage November 1–7, 2026, Pacific · Lower priority
CMS issued Transmittal 14035 (Pub. 100-04, CR 14645) on November 5, 2026, instructing contractors to implement coding for expanded coverage of allogeneic hematopoietic stem cell transplantation (HSCT) for Medicare patients with myelodysplastic syndromes (MDS) who meet specific criteria, under National Coverage Determination (NCD) 110.23. The effective date is June 30, 2026 and implementation is April 5, 2027. Contractors are to add ICD-10-PCS (the ICD-10 Procedure Coding System) codes XW033BA and XW043BA as covered procedures effective June 30, 2026, make Type of Bill (TOB) 13X and 85X payable for dates of service on or after October 1, 2026, and return to provider claims not submitted on a valid TOB.
Background
The transmittal describes HSCT as a process that includes mobilization, harvesting and transplant of stem cells and the administration of high dose chemotherapy and/or radiotherapy before the transplant, and MDS as a heterogeneous group of hematologic disorders characterized by cytopenia due to bone marrow failure and by the potential development of acute myeloid leukemia. Coverage of all other stem cell transplantation indications not otherwise specified is made by local Medicare Administrative Contractors (MACs) under section 1862(a)(1)(A) of the Social Security Act. Claims on an invalid TOB were previously denied; the new edit returns them to the provider.
Who this affects
Hospitals with stem cell transplant programs (Part A claims), billing staff.
Why it matters
Inference: transplant programs may need to hold or later adjust affected claims until MAC systems implement the change in April 2027.
Recommended action
- Transplant billing: check claims for allogeneic HSCT for MDS with dates of service on or after 2026-06-30 against the new codes and TOB rules.
Scope and timing
- Authority status
- Guidance
- Responsible owner
- Revenue Cycle (transplant billing)
- Publication date
- 2026-11-05 (issued)
- Effective date
- 2026-06-30 (date of service, unless otherwise specified)
- Implementation date
- 2027-04-05
- Other dates
- TOB 13X and 85X payable for dates of service on or after 2026-10-01; return-to-provider edit for invalid TOB for dates of service on or after 2024-03-06
Not established
The underlying NCD 110.23 decision date was not retrieved. The Medicare Learning Network (MLN) Matters article for CR 14645 was not listed on the transmittal index when the index was checked.
Sources
Complete edition and supplemental material
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