32856
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Documentation of current effective antiretroviral therapy (ART) for members with HIV.
- Documentation of nutritional assessment demonstrating absence of chronic wasting or severe malnutrition (eg, weight history, BMI, nutritionist evaluation).
- Documentation of cognitive assessment demonstrating no progressive cognitive impairment.
- Documentation of assessment of ability to adhere to post-transplant regimen and availability/role of caregiver support.
Key Coverage Criteria
- Lung or lobar transplantation is consideredmedically necessaryfor individuals who meet the general individual selection criteriaandhave irreversible, progressively disabling, end-stage pulmonary disease including, but not limited to, one or more of the conditions listed below.
- Restrictive lung disease, examples of which include, but are not limited to:Idiopathic pulmonary fibrosis (IPF);Interstitial pulmonary fibrosis;Scleroderma;Sarcoidosis;Extrinsic allergic alveolitis;Post-chemotherapy disease;Asbestosis.
- Idiopathic pulmonary fibrosis (IPF);
- Interstitial pulmonary fibrosis;
- Scleroderma;
- Sarcoidosis;
7 Active Policies
AMBETTER-CP.MP.57 — Lung Transplantation
ANTHEM-MP-A053821 — TRANS.00009 Lung and Lobar Transplantation
BCBSIL-SUR703.010 — Lung and Lobar Lung Transplant
BCBSMT-SUR703.010 — Lung and Lobar Lung Transplant
BCBSNM-SUR703.010 — Lung and Lobar Lung Transplant
Related Codes
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