44799
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 individual compliance with medical management
- Medical record documentation demonstrating intestinal failure (cause and inability to maintain protein-energy, fluid, electrolyte, or micronutrient balance)
- Documentation of adequate cardiopulmonary status (clinical assessment/results)
- Clinical documentation demonstrating intolerance of TPN, such as records of multiple or prolonged hospitalizations for TPN-related complications.
Key Coverage Criteria
- Small bowel-liver transplant or multivisceral transplant for pediatric and adult individuals with intestinal failure characterized by loss of absorption and inability to maintain protein-energy, fluid, electrolyte, or micronutrient homeostasis.
- Small bowel/liver transplant or multivisceral transplant is medically necessary for patients managed with long-term total parenteral nutrition (TPN) who have developed evidence of impending end-stage liver failure.
- Small bowel/liver retransplant or multivisceral retransplant is medically necessary after a failed primary small bowel/liver transplant or multivisceral transplant.
- Intestinal failure due to surgical resection, congenital defect, or disease-associated loss of absorption characterized by inability to maintain protein-energy, fluid, electrolyte, or micronutrient balance
- Short bowel syndrome as an example of intestinal failure
- Candidates must have adequate cardiopulmonary status
6 Active Policies
BCBSIL-SUR703.009 — Small Bowel/Liver and Multivisceral Transplant
BCBSMT-SUR703.009 — Small Bowel/Liver and Multivisceral Transplant
BCBSNM-SUR703.009 — Small Bowel/Liver and Multivisceral Transplant
BCBSOK-SUR703.009 — Small Bowel/Liver and Multivisceral Transplant
REGENCE-SUR175 — Plugs for Enteric and Anorectal Fistula Repair
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.