Islet Transplantation

This policy covers islet transplantation, specifically autologous islet autotransplantation performed at the time of total or near‑total pancreatectomy for chronic pancreatitis to preserve endocrine function and reduce postoperative insulin dependence, and consideration of allogeneic islet transplantation for adults with type 1 diabetes who have recurrent severe hypoglycemia or other severe metabolic complications despite intensive insulin management. Major limitations: autologous transplants are only covered as an adjunct to pancreatectomy; allogeneic therapy (including donislecel‑jujn/Lantidra) is restricted or considered investigational/not medically necessary in many settings, is generally limited to adults, is subject to member benefits/state rules, and may be excluded for patients with well‑controlled diabetes or significant comorbidities and carries risks from infusion and long‑term immunosuppression.

"Autologous pancreas islet transplantation as an adjunct to total or near‑total pancreatectomy in individuals with chronic pancreatitis."