Does S2054 require prior authorization?

No, S2054 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for S2054?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Oncology records showing absence of active malignancy or documentation of complete resection / assessment of low likelihood of recurrence and acceptable risk.
Functional status and rehabilitation records; documentation of ventilatory status and whether ambulatory ECMO is being used as a bridge-to-transplant.
Laboratory results: serum bilirubin (< 2.5 mg/dL) and measured or estimated creatinine clearance (> 50 ml/min/kg).
Life expectancy assessment documenting > 2 years expected survival absent cardiopulmonary disease.

Heart-lung transplantation is medically necessary for persons with severe refractory heart failure plus either end-stage lung disease or irreversible pulmonary hypertension when the selection criteria are met and no absolute contraindications are present.
Severe (New York Heart Association (NYHA) classification III or IV) heart failure where right ventricular function would not be restored with lung transplant alone.
Chronic obstructive pulmonary disease with severe heart failure.
Congenital heart disease associated with pulmonary hypertension that are not amenable to lung transplantation and repair by standard cardiac surgery.
Cystic fibrosis with severe heart failure.
Eisenmenger's complex with irreversible pulmonary hypertension and severe heart failure.

AMBETTER-CP.MP.58 — Intestinal and Multivisceral Transplant

AETNA-CPB-0597 — Heart-Lung Transplantation

ANTHEM-MP-A053824 — TRANS.00013 Small Bowel, Small Bowel/Liver and Multivisceral Transplantation

BCBSIL-SUR703.009 — Small Bowel/Liver and Multivisceral Transplant

BCBSMT-SUR703.009 — Small Bowel/Liver and Multivisceral Transplant

Ask Verity about documentation requirements, denial risks, or coverage in your state.