TRANS.00010 Autologous and Allogeneic Pancreatic Islet Cell Transplantation

This policy addresses autologous and allogeneic pancreatic islet cell transplantation, including use of FDA‑approved donislecel-jujn (Lantidra). Autologous islet transplantation is covered only when performed as an adjunct to a total or near‑total pancreatectomy for individuals with chronic pancreatitis. All other uses of autologous islet transplantation and all allogeneic islet transplantation are investigational and not medically necessary; for multi‑organ transplants, each organ must meet its own criteria, with case-by-case review when concurrent conditions affect candidacy.

"Autologous pancreatic islet cell transplantation is consideredmedically necessaryas an adjunct to a total or near total pancreatectomy for individuals with chronic pancreatitis."

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