Liver and Liver-Kidney Transplantation - (0355)

Cigna covers liver transplantation (and select retransplantation and simultaneous liver‑kidney for adults) for specified diagnoses — e.g., end‑stage liver disease, HCC meeting T2 or properly downstaged per NLRB/OPTN rules, hepatoblastoma, selected cholangiocarcinomas, solitary iCCA/mixed ≤3 cm with ≥6 months stability, NET (GEP) with resected primaries and no extra‑hepatic recurrence, CRLM meeting strict criteria, HEHE, certain hepatic adenomas, cystic fibrosis, FAP, HPS, portopulmonary hypertension, and primary hyperoxaluria — and excludes transplants when listed contraindications (e.g., ongoing alcohol abuse, specified malignancies/infections) or failure to meet the specific indication criteria are present. Approval requires strict adherence to the 2/27/2025 NLRB Adult Transplant Oncology guidance and OPTN policies plus extensive, timely documentation (imaging, pathology, hemodynamics, AFP/lab thresholds such as AFP ≤1,000 for standardized T2 exceptions, proof of treatments and stability periods, and specific timing windows like imaging within 1 month, FEV1/echo within 30 days, and RHC/post‑treatment values within required intervals).