Kidney Transplantation, Pancreas-Kidney Transplantation, and Pancreas Transplantation Alone - (0146)

Cigna covers kidney transplant, simultaneous pancreas-kidney (SPK), pancreas transplant alone (PTA), and pancreas-after-kidney (PAK) only when specified clinical indications are met (e.g., adult GFR/CrCl ≤20 mL/min/1.73 m2, pediatric stage 4 CKD/ESRD on dialysis; SPK/PTA/PAK require adult insulin dependence, pancreatic exocrine insufficiency, or technical need) and excludes candidates with listed absolute contraindications (many active/advanced malignancies, active infections, significant comorbidities, active substance use or nonadherence; living/segmental pancreas transplants are experimental; HIV only allowed with strict criteria). Approval requires documentation of measured/estimated GFR/CrCl and dialysis status, evidence of insulin use or pancreatic insufficiency, oncology clearance per the appendix for prior cancers, HIV labs showing CD4>200/undetectable RNA with stable ART >3 months if applicable, psychosocial/compliance and organ‑specific evaluations (e.g., age ≤65, BMI ≤35, cardiopulmonary clearance for SPK/PAK), UNOS/OPTN registration criteria, and appropriate billing codes.