Status

This policy addresses combined heart–lung transplantation. It is medically necessary when general transplant selection criteria are met and the patient has one of the following: irreversible primary pulmonary hypertension with heart failure; secondary pulmonary hypertension with heart failure due to pulmonary fibrosis, cystic fibrosis, COPD/emphysema; or Eisenmenger’s complex/other congenital heart disease with irreversible pulmonary hypertension—and there are no contraindications per AST (e.g., metastatic cancer). It is investigational/not medically necessary if these criteria are not met; for multi-organ transplants, criteria must be met for each organ and cases with potential conflicting comorbidities are reviewed individually.

"Heart/lung transplantation is consideredmedically necessarywhen the following clinical indicationsandthe general individual selection criteria listed below are met."