Lung and Lobar Lung Transplant

This policy covers medically necessary lung and lobar lung transplantation (including living- or deceased-donor lobar transplants) for carefully selected candidates with end‑stage pulmonary disease—examples include cystic fibrosis, COPD/emphysema, pulmonary hypertension, alpha‑1 antitrypsin deficiency, bronchiectasis, interstitial lung disease, and retransplantation after graft failure. Coverage requires meeting transplant selection criteria and exhaustion of maximal medical/surgical therapy, excludes cases with major contraindications (e.g., active or high‑risk recurrent malignancy, untreated systemic infection, colonization with highly resistant/virulent organisms, or prohibitive psychosocial/substance‑use issues), does not cover ex‑vivo lung perfusion systems (considered experimental), and prohibits coverage for organs procured via forced organ harvesting or from designated countries.

"End-stage pulmonary disease (ESPD) in carefully selected individuals as a candidate for lung transplantation"