Pancreatic Islet Cell Transplantation - (0107)

Autologous pancreatic islet cell transplantation (TPIAT) is covered as medically necessary when performed with total or near-total pancreatectomy for severe, chronic pancreatitis refractory to standard therapy (eligible CPT/HCPCS codes apply), while allogeneic islet transplantation (including Lantidra™) and bioartificial pancreas devices are considered experimental/investigational and not covered; recipients are not eligible for transplant travel benefits. Coverage requires documentation of severe refractory chronic pancreatitis and failure of prior treatments, multidisciplinary evaluation at an expert center, informed consent about risks (including postsurgical diabetes), detailed operative/islet isolation and infusion records, and exclusion of type 1 diabetes, with claims subject to denial if required coding or documentation is missing.

"Pancreatic islet cell transplantation is considered a core medical service (not a transplant services benefit)."