Mountain State Medical Policy Bulletin

Section: Surgery
Number: S-38
Topic: Organ and Tissue Acquisition/Transplantation
Effective Date: August 1, 2005
Issued Date: August 1, 2005
Date Last Reviewed: 06/2005

General Policy Guidelines

Indications and Limitations of Coverage

Physicians' services for the following medically recognized organ or tissue transplants are eligible for payment:

Bone Marrow (38230, 38240, 38241)
Cornea (65710-65755)
Heart (33940-33945)
Heart-Lung (33930-33935, 33944)
Islet Cell Autotransplantation (48160)
Kidney (50300-50380, 50547)
Liver (47133-47147)
Lung (32850-32856)
Multivisceral (S2054, S2055)
Simultaneous Pancreas (48550-48556) and Kidney (50300-50380, 50547, S2065)
Small Bowel (44132-44136, 44715-44721)
Small Bowel/Liver (44132, 44133, 44715-44721, 47133, 47143-47147, S2053)
Solitary Pancreas (48550-48556)

The following transplants are considered experimental/investigational and not eligible for payment. A participating, preferred, or network provider can bill the member for the denied service.

  • Adrenal to Brain (S2103) - Scientific evidence does not demonstrate the efficacy of adrenal to brain transplantation
  • Heterograft (Animal to Human ) - Xenotransplantation from primate donors have not yet received the approval of the FDA for clinical trials
  • Islet Cell Allotransplantation (S2102, G0341, G0342, G0343) - Scientific evidence indicates there is a very low success rate with this transplant. Islet cell allotransplantation is still being performed in a clinical trial setting with no long-term outcomes available.

All other transplants not referenced on this policy are considered experimental/investigational and not eligible for payment.

NOTE:
See Medical Policy Bulletins S-73, S-116 through S-127, and S-144 for additional information on transplants and PRN references.

The following guidelines are used to process claims for eligible transplant procedures:

  • Payment should be made for transplant services performed for a recipient who is a Mountain State member, including the removal of an organ from a living donor or cadaver. Payment is also made for the removal of an organ from a living donor who is a Mountain State member, even though the recipient is not. When only the recipient is a Mountain State member, donor benefits are limited to only those not provided or available to the donor from any other source.

    Payment may be made under the recipient's Mountain State coverage only when all other donor sources (e.g., other insurance coverages, government program funding, etc.) have been exhausted. Removal of an organ from a cadaver is payable only when the recipient is a Mountain State member.

  • Based on the above guidelines, payment should be made for those services provided by the surgeon for the removal of the organ from the living donor or cadaver for the actual transplant.

  • Testing performed to determine donor compatibility is classified as screening because the potential donor is asymptomatic. Liability for potential donor testing lies with the potential donor’s health plan.

  • Once the donor has been established, payment may be made for the preoperative testing and medical examination for the donor in preparation for the surgery for the removal of the organ or tissue. The testing (e.g., pathology tests, chest x-ray, and EKG) and medical examination are medically necessary prior to the administration of general anesthesia and/or major surgery.

  • Payment may not be made for the purchase price of human organs which are sold rather than donated to the recipient.

  • Due to the nature of organ transplant surgery, team surgery is frequently involved. See Medical Policy Bulletin S-12 for additional information.

Coverage for other organ transplants is determined according to individual or group customer benefits.


NOTE:
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 circumstances may warrant individual consideration, based on review of applicable medical records.

Procedure Codes

328503285132852328533285432855
328563393033933339353394033944
339453823038240382414413244133
441354413644715447204472147133
471354713647140471414714247143
471444714547146471474816048550
485514855248554485565030050320
503235032550327503285032950340
503605036550370503805054765710
657306575065755G0341G0342G0343
S2053S2054S2055S2065S2102S2103

Traditional Guidelines

Refer to General Policy Guidelines

FEP Guidelines

Preauthorization is required for heart, liver, pancreas, bone marrow, heart/lung, lung, small bowel, and small bowel/liver transplantation. Preauthorization does not apply to other eligible transplant procedures: kidney and cornea. All other transplant procedures are excluded.

Also refer to General Policy Guidelines

PPO Guidelines

Refer to General Policy Guidelines

Managed Care POS Guidelines

Refer to General Policy Guidelines

Publications

References

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Glossary





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 circumstances may warrant individual consideration, based on review of applicable medical records.

Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.

Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Mountain State Blue Cross Blue Shield plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.

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