Heart, Lung, and Heart-Lung Transplantation - (0129)

Cigna covers heart, lung, and combined heart‑lung transplants for specified organ‑based indications (e.g., adult/pediatric end‑stage heart failure, refractory ventricular arrhythmias or angina, end‑stage lung disease, select lung‑limited adenocarcinomas Stage II or lower, and combined cardiopulmonary failure) and excludes cases with listed contraindications such as advanced/high‑recurrence malignancies, uncontrolled/ongoing systemic infections, severe noncardiopulmonary organ dysfunction, active substance use or noncompliance, uncontrolled HIV, and other ISHLT absolute contraindications. Key requirements include comprehensive documentation of disease severity and testing (NYHA class or need for continuous inotropes/MCSD, CPET, RHC, PFTs, chest CT, pathology/staging), oncology clearance and required wait times when applicable, organ‑specific labs/imaging, vaccination/infection screening, and evidence of transplant suitability (renal/hepatic function, rehabilitation potential, stable HIV therapy if present).