Kidney Transplant

This policy covers kidney transplantation (living or deceased donor) as medically necessary for carefully selected candidates, including patients age ≥2 years with end‑stage renal disease, advanced CKD (generally stage 4–5 or eGFR/creatinine thresholds), failing allograft, or dialysis dependence, and infants/children with documented evaluation and acceptance by the transplant center committee. Coverage requires transplant committee evaluation and documented eGFR/creatinine criteria (e.g., ≥2 years: eGFR ≤20 mL/min), excludes transplants performed in or involving organs procured from China or other jurisdictions designated for forced organ harvesting, and is contraindicated or excluded for active substance abuse, severe non‑compliance, untreated systemic infection, current/high‑risk malignancy, or any indication not listed (considered experimental).

"Kidney transplant alone (living or deceased donor) may be medically necessary for carefully selected candidates."