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DI 23022.080: List of Compassionate Allowance (CAL) Conditions

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  • Effective Dates: 09/15/2017 - Present
  • Effective Dates: 08/17/2018 - Present
  • TN 15 (09-17)
  • TN 17 (08-18)
  • DI 23022.080 List of Compassionate Allowance (CAL) Conditions
  • The following is a complete list of CAL conditions:
  • Section Title
  • Section Number
  • Acute Leukemia
  • DI 23022.085
  • Adrenal Cancer -- with distant metastases or inoperable, unresectable or recurrent
  • DI 23022.090
  • Adult Non-Hodgkin Lymphoma
  • DI 23022.921
  • Adult Onset Huntington Disease
  • DI 23022.923
  • Aicardi-Goutieres Syndrome
  • DI 23022.665
  • Alexander Disease (ALX) -- Neonatal and Infantile
  • DI 23022.095
  • Allan-Herndon-Dudley Syndrome
  • DI 23022.925
  • Alobar Holoprosencephaly
  • DI 23022.670
  • Alpers Disease
  • DI 23022.675
  • Alpha Mannosidosis - Type II and III
  • Alpha Mannosidosis -- Type II and III
  • DI 23022.680
  • Alstrom Syndrome
  • DI 23022.350
  • Alveolar Soft Part Sarcoma
  • DI 23022.927
  • Amegakaryocytic Thrombocytopenia
  • DI 23022.355
  • Amyotrophic Lateral Sclerosis (ALS)
  • DI 23022.100
  • Anaplastic Adrenal Cancer -- with distant metastases or inoperable, unresectable or recurrent
  • DI 23022.105
  • Angelman Syndrome
  • DI 23022.600
  • Aortic Atresia
  • DI 23022.540
  • Angiosarcoma
  • DI 23022.106
  • Aplastic Anemia
  • DI 23022.929
  • Astrocytoma -- GRADE III and IV
  • DI 23022.110
  • Ataxia Telangiectasia
  • DI 23022.360
  • Atypical Teratoid/Rhabdoid Tumor
  • DI 23022.111
  • Batten Disease
  • DI 23022.365
  • Beta Thalassemia Major
  • DI 23022.931
  • Bilateral Optic Atrophy- Infantile
  • Bilateral Optic Atrophy -- Infantile
  • DI 23022.933
  • Bilateral Retinoblastoma
  • DI 23022.370
  • Bladder Cancer -- with distant metastases or inoperable or unresectable
  • DI 23022.115
  • Breast Cancer -- with distant metastases or inoperable or unresectable
  • DI 23022.125
  • CACH- Vanishing White Matter Disease- Infantile and Childhood Onset Forms
  • CACH -- Vanishing White Matter Disease -- Infantile and Childhood Onset Forms
  • DI 23022.127
  • Canavan Disease (CD)
  • DI 23022.130
  • Carcinoma of Unknown Primary Site
  • DI 23022.685
  • Cardiac Amyloidosis- AL Type
  • DI 23022.580
  • Caudal Regression Syndrome- Types III and IV
  • DI 23022.935
  • Cerebro Oculo Facio Skeletal (COFS) Syndrome
  • DI 23022.135
  • Cerebrotendinous Xanthomatosis
  • DI 23022.690
  • Child Neuroblastoma- - with distant metastasis or recurrent
  • DI 23022.695
  • Child Non-Hodgkin Lymphoma- - recurrent
  • DI 23022.700
  • Child T-Cell Lymphoblastic Lymphoma
  • DI 23022.937
  • Chondrosarcoma- - with multimodal therapy
  • DI 23022.705
  • Chronic Idiopathic Intestinal Pseudo Obstruction
  • DI 23022.136
  • Chronic Myelogenous Leukemia -- Blast Phase
  • DI 23022.140
  • Coffin-Lowry Syndrome
  • DI 23022.141
  • Congenital Lymphedema
  • DI 23022.939
  • Congenital Myotonic Dystrophy
  • DI 23022.143
  • Cornelia de Lange Syndrome- - Classic Form
  • DI 23022.710
  • Corticobasal Degeneration
  • DI 23022.605
  • Creutzfeldt-Jakob Disease (CJD) -- Adult
  • DI 23022.145
  • Cri du Chat Syndrome
  • DI 23022.375
  • Degos Disease, Systemic
  • DI 23022.380
  • DeSanctis Cacchione Syndrome
  • DI 23022.941
  • Dravet Syndrome
  • DI 23022.943
  • Early-Onset Alzheimer’s Disease
  • DI 23022.385
  • Edwards Syndrome (Trisomy 18)
  • DI 23022.390
  • Eisenmenger Syndrome
  • DI 23022.545
  • Endometrial Stromal Sarcoma
  • DI 23022.945
  • Endomyocardial Fibrosis
  • DI 23022.550
  • Ependymoblastoma (Child Brain Tumor)
  • DI 23022.150
  • Esophageal Cancer
  • DI 23022.155
  • Esthesioneuroblastoma
  • DI 23022.156
  • Ewing Sarcoma
  • DI 23022.715
  • Farber’s Disease (FD) -- Infantile
  • DI 23022.160
  • Fatal Familial Insomnia
  • DI 23022.949
  • Fibrodysplasia Ossificans Progressiva
  • DI 23022.395
  • Follicular Dendritic Cell Sarcoma - - metastatic or recurrent
  • Fibrolamellar Cancer
  • DI 23022.163
  • Follicular Dendritic Cell Sarcoma -- metastatic or recurrent
  • DI 23022.720
  • Friedreichs Ataxia (FRDA)
  • DI 23022.165
  • Frontotemporal Dementia (FTD) Picks Disease --Type A – Adult
  • Frontotemporal Dementia (FTD) Picks Disease -- Type A – Adult
  • DI 23022.170
  • Fryns Syndrome
  • DI 23022.951
  • Fucosidosis – Type I
  • DI 23022.725
  • Fukuyama Congenital Muscular Dystrophy
  • DI 23022.400
  • Fulminant Giant Cell Myocarditis
  • DI 23022.953
  • Galactosialidosis – Early and Late Infantile Types
  • DI 23022.730
  • Gallbladder Cancer
  • DI 23022.175
  • Gaucher Disease (GD) --Type 2
  • DI 23022.180
  • Glioblastoma Multiforme (Brain Tumor)
  • DI 23022.185
  • Glioma Grade III and IV
  • DI 23022.735
  • Giant Axonal Neuropathy
  • DI 23022.181
  • Gluteric Acidemia – Type II
  • DI 23022.470
  • Head and Neck Cancers -- with distant metastasis or inoperable or uresectable
  • DI 23022.190
  • Heart Transplant Graft Failure
  • DI 23022.555
  • Heart Transplant Wait List – 1A/1B
  • DI 23022.560
  • Hemophagocytic Lymphohistiocytosis
  • DI 23022.405
  • Hepatoblastoma
  • DI 23022.745
  • Hepatopulmonary Syndrome
  • DI 23022.955
  • Hepatorenal Syndrome
  • DI 23022.957
  • Histiocytosis Syndromes
  • DI 23022.750
  • Hoyeaal-Hreidarsson Syndrome
  • DI 23022.191
  • Hutchinson-Gilford Progeria Syndrome
  • DI 23022.755
  • Hydranencephaly
  • DI 23022.760
  • Hypocomplementemic Urticarial Vasculitis Syndrome
  • DI 23022.765
  • Hypophosphatasia- Perinatal (Lethal) and Infantile Onset Types
  • DI 23022.770
  • Hypoplastic Left Heart Syndrome
  • DI 23022.565
  • I Cell Disease
  • DI 23022.775
  • Idiopathic Pulmonary Fibrosis
  • DI 23022.420
  • Infantile Free Sialic Acid Storage Disease
  • DI 23022.780
  • Infantile Neuroaxonal Dystrophy (INAD)
  • DI 23022.195
  • Infantile Neuronal Ceroid-Lipofuscinoses
  • DI 23022.425
  • Inflammatory Breast Cancer (IBC)
  • DI 23022.200
  • Intracranial Hemangiopericytoma
  • DI 23022.201
  • Jervell and Lange-Nielsen Syndrome
  • DI 23022.959
  • Joubert Syndrome
  • DI 23022.202
  • Junctional Epidermolysis Bullosa Lethal Type
  • DI 23022.430
  • Juvenile Onset Huntington Disease
  • DI 23022.785
  • Kidney Cancer -- inoperable or unresectable
  • DI 23022.205
  • Kleefstra Syndrome
  • DI 23022.207
  • Krabbe Disease (KD) --Infantile
  • DI 23022.210
  • Kufs Disease Type A and B
  • DI 23022.790
  • Large Intestine Cancer -- with distant metastasis or inoperable, unresectable or recurrent
  • DI 23022.215
  • Late Infantile Neuronal Ceroid-Lipofuscinoses
  • DI 23022.435
  • Leigh’s Disease
  • DI 23022.440
  • Leiomyosarcoma
  • DI 23022.961
  • Leptomeningeal Carcinomatosis
  • DI 23022.216
  • Lesch-Nyhan Syndrome (LNS)
  • DI 23022.220
  • Lewy Body Dementia
  • DI 23022.610
  • Liposarcoma – metastatic or recurrent
  • DI 23022.221
  • Lissencephaly
  • DI 23022.795
  • Liver Cancer
  • DI 23022.225
  • Lowe Syndrome
  • DI 23022.615
  • Lymphomatoid Granulomatosis - Grade III
  • DI 23022.800
  • Malignant Brain Stem Gliomas - Childhood
  • DI 23022.805
  • Malignant Ectomesenchymoma
  • DI 23022.226
  • Malignant Gastrointestinal Stromal Tumor
  • DI 23022.963
  • Malignant Germ Cell Tumor
  • DI 23022.965
  • Malignant Multiple Sclerosis
  • DI 23022.620
  • Malignant Renal Rhabdoid Tumor
  • DI 23022.227
  • Mantle Cell Lymphoma (MCL)
  • DI 23022.230
  • Maple Syrup Urine Disease
  • DI 23022.445
  • Marshall-Smith Syndrome
  • DI 23022.231
  • Mastocytosis - Type IV
  • DI 23022.815
  • MECP 2 Duplication Syndrome
  • DI 23022.967
  • Medulloblastoma - with metastasis
  • DI 23022.820
  • Megacystis Microcolon Intestinal Hypoperistalsis Syndrome
  • DI 23022.233
  • Megalencephaly-Capillary Malformation Syndrome
  • DI 23022.234
  • Menkes Disease - Classic or Infantile Onset Form
  • DI 23022.969
  • Merkel Cell Carcinoma - with metastasis
  • DI 23022.825
  • Merosin Deficient Congenital Muscular Dystrophy
  • DI 23022.450
  • Metachromatic Leukodystrophy - Late Infantile
  • DI 23022.235
  • Mitral Valve Atresia
  • DI 23022.575
  • Mixed Dementia
  • DI 23022.455
  • MPS I, formerly known as Hurler Syndrome
  • DI 23022.415
  • MPS II, formerly known as Hunter Syndrome
  • DI 23022.410
  • MPS III, formerly known as Sanfilippo Syndrome
  • DI 23022.495
  • Mucosal Melanoma
  • DI 23022.460
  • Multicentric Castleman Disease
  • DI 23022.625
  • Multiple System Atrophy
  • DI 23022.630
  • Myocolonic Epilepsy and Ragged Red Fibers Syndrome
  • DI 23022.830
  • Neonatal Adrenoleukodystrophy
  • DI 23022.465
  • (Neonatal) Glutaric Acidemia
  • DI 23022.470
  • Nephrogenic Systemic Fibrosis
  • DI 23022.835
  • NFU-1 Mitochondrial Disease
  • DI 23022.971
  • Niemann-Pick Disease (NPD) -- type A
  • DI 23022.240
  • Niemann-Pick Disease Type C
  • DI 23022.475
  • Nonketotic Hyperglycinemia
  • DI 23022.973
  • Non-Small Cell Lung Cancer -- with metastases to or beyond the hilar nodes or inoperable, unresectable or recurrent
  • DI 23022.245
  • Obliterative Bronchiolitis
  • DI 23022.840
  • Ohtahara Syndrome
  • DI 23022.845
  • Oligodendroglioma Brain Tumor- Grade III
  • DI 23022.246
  • Ornithine Transcarbamylase (OTC) Deficiency
  • DI 23022.250
  • Orthochromatic Leukodystrophy with Pigmented Glia
  • DI 23022.850
  • Osteogenesis Imperfecta (OI) -- Type II
  • DI 23022.255
  • Osteosarcoma, formerly known as Bone Cancer -- with distant metastases or inoperable or unresectable
  • DI 23022.120
  • Ovarian Cancer -- with distant metastases or inoperable or unresectable
  • DI 23022.260
  • Pallister-Killian Syndrome
  • DI 23022.261
  • Pancreatic Cancer
  • DI 23022.265
  • Paraneoplastic Pemphigus
  • DI 23022.635
  • Patau Syndrome (Trisomy 13)
  • DI 23022.480
  • Pearson Syndrome
  • DI 23022.855
  • Pelizaeus-Merzbacher Disease- - Classic Form
  • DI 23022.860
  • Pelizaeus-Merzbacher Disease- - Connatal Form
  • DI 23022.865
  • Peripheral Nerve Cancer- - metastatic or recurrent
  • DI 23022.870
  • Peritoneal Mesothelioma
  • DI 23022.270
  • Peritoneal Mucinous Carcinomatosis
  • DI 23022.975
  • Perry Syndrome
  • DI 23022.875
  • Phelan-McDermid Syndrome
  • DI 23022.977
  • Pleural Mesothelioma
  • DI 23022.275
  • Pompe Disease -- Infantile
  • DI 23022.280
  • Primary Central Nervous System Lymphoma
  • DI 23022.640
  • Primary Effusion Lymphoma
  • DI 23022.645
  • Primary Progressive Aphasia
  • DI 23022.485
  • Progressive Bulbar Palsy
  • DI 23022.281
  • Progressive Multifocal Leukoencephalopathy
  • DI 23022.490
  • Progressive Supranuclear Palsy
  • DI 23022.650
  • Prostate Cancer- Hormone Refractory Disease— or with visceral metastases
  • DI 23022.282
  • Pulmonary Atresia
  • DI 23022.585
  • Pulmonary Kaposi Sarcoma
  • DI 23022.655
  • Retinopathy of Prematurity- Stage V
  • DI 23022.979
  • Rett (RTT) Syndrome
  • DI 23022.285
  • Revesez Syndrome
  • DI 23022.286
  • Rhabdomyosarcoma
  • DI 23022.880
  • Rhizomelic Chondrodysplasia Punctata
  • DI 23022.885
  • Roberts Syndrome
  • DI 23022.981
  • Salivary Tumors
  • DI 23022.290
  • Sandhoff Disease
  • DI 23022.295
  • Schindler Disease - - Type I
  • DI 23022.890
  • Seckel Syndrome
  • DI 23022.296
  • Severe Combined Immunodeficiency- Childhood
  • DI 23022.983
  • Single Ventricle
  • DI 23022.590
  • Sinonasal Cancer
  • DI 23022.985
  • Sjogren-Larsson Syndrome
  • DI 23022.297
  • Skin Malignant Melanoma—with metastases
  • DI 23022.810
  • Small -Cell Cancer of the Large Intestine
  • Small-Cell Cancer of the Large Intestine
  • DI 23022.300
  • Small- Cell Cancer of the Ovary
  • Small-Cell Cancer of the Ovary
  • DI 23022.305
  • Small- Cell Cancer of the Prostate
  • Small-Cell Cancer of the Prostate
  • DI 23022.310
  • Small- Cell Cancer of the Thymus
  • Small-Cell Cancer of the Thymus
  • DI 23022.311
  • Small- Cell Cancer of the Uterus
  • Small-Cell Cancer of the Uterus
  • DI 23022.315
  • Small- Cell Lung Cancer
  • Small-Cell Lung Cancer
  • DI 23022.320
  • Small Intestine Cancer -- with distant metastases or inoperable, unresectable or recurrent
  • DI 23022.325
  • Smith Lemli Opitz Syndrome
  • DI 23022.895
  • Soft Tissue Sarcoma – with distant metastases or recurrent
  • DI 23022.326
  • Spinal Muscular Atrophy (SMA) -- Types 0 and 1
  • DI 23022.330
  • Spinal Nerve Root Cancer- - metastatic or recurrent
  • DI 23022.900
  • Spinocerebellar Ataxia
  • DI 23022.500
  • Stiff Person Syndrome
  • DI 23022.905
  • Stomach Cancer -- with distant metastases or inoperable, unresectable or recurrent
  • DI 23022.335
  • Subacute Sclerosing Panencephalitis
  • DI 23022.505
  • Superficial Siderosis of the Central Nervous System
  • DI 23022.337
  • Tabes Dorsalis
  • DI 23022.910
  • Tay Sachs Disease
  • DI 23022.510
  • Tetrasomy 18p
  • DI 23022.343
  • Thanatophoric Dysplasia, Type 1
  • DI 23022.515
  • The ALS/Parkinsonism Dementia Complex
  • DI 23022.660
  • Thyroid Cancer
  • DI 23022.340
  • Transplant Coronary Artery Vasculopathy
  • DI 23022.987
  • Tricuspid Atresia
  • DI 23022.595
  • Ullrich Congenital Muscular Dystrophy
  • DI 23022.520
  • Ureter Cancer -- with distant metastases or inoperable, unresectable or recurrent
  • DI 23022.345
  • Usher Syndrome- Type I
  • DI 23022.989
  • Ventricular Assist Device Recipient
  • DI 23022.570
  • Walker Warburg Syndrome
  • DI 23022.525
  • Wolf-Hirschhorn Syndrome
  • DI 23022.915
  • Wolman Disease
  • DI 23022.530
  • Xeroderma Pigmentosum
  • DI 23022.920
  • X-Linked Lymphoproliferative Disease
  • DI 23022.346
  • X-Linked Myotubular Myopathy
  • DI 23022.347
  • Zellweger Syndrome
  • DI 23022.535
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