Thymus Tissue Transplantation - (0561)

Cigna covers a single administration of thymus tissue transplantation (Rethymic) only for pediatric patients (≤17 years) with congenital athymia (including complete DiGeorge anomaly or FOXN1 deficiency) and explicitly excludes all other indications—including SCID—and patients with contraindications seen in trials (e.g., HIV, CMV requiring immunosuppression, ventilator dependence, poor surgical candidacy, or prior immune-reconstitution attempts). Coverage requires T‑cell or naïve T‑cell counts <50/mm3, documented absence of genetic defects associated with SCID, age verification, supporting genetic testing and flow cytometry (two assays: one within 3 months and one within 1 month before administration), preoperative surgical/anesthesia clearance, and is limited to one administration.

"A single administration of thymus tissue transplantation is considered medically necessary in a pediatric individual (age 17 and under) when the following criteria are met:"