CPT 33945, in plain terms, covers A surgical procedure where a donor heart is removed and placed into a patient's chest to replace their diseased heart. CPT 33945 is referenced in 7 tracked payer policy changes from Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 33945 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 33945 on AAPC
Effective 10/01/2026, the Code Reference section adds the new ICD-10 diagnosis codes I42.00, I42.01, I42.09, I42.81 and I42.89 for cardiomyopathy. Diagnosis codes I42.0 and I42.8 are marked as deleted 09/30/2026. A human heart transplant is considered medically necessary for selected adult and pediatric patients with end-stage heart failure who meet the listed criteria for patient selection and priority allocation.
Excellus BlueCross BlueShield policy 7.02.06 considers heart transplantation medically appropriate for select adults with end-stage heart disease that has not responded to other medical or surgical therapy, when recipient selection criteria are met. Acceptable heart indications include hemodynamic compromise with maximal oxygen consumption below 10 ml/kg/min, refractory cardiogenic shock, or dependence on intravenous inotropic support; severe ischemia not amenable to bypass surgery or angioplasty; and recurrent symptomatic ventricular arrhythmias refractory to accepted therapy. Heart-lung transplantation is considered medically appropriate for carefully selected individuals with end-stage cardiac and pulmonary disease, such as Eisenmenger complex, cystic fibrosis with severe heart failure, or COPD with heart failure. Pre-transplant evaluation documentation should include clinical, psycho-social, performance status, oral health, laboratory, cardiac, pulmonary and age-appropriate screening information, with a rationale where testing is not performed. Transplant reauthorization is required annually while on the waiting list. The current effective date is July 16, 2026, and the annual review states policy intent is unchanged.
Aetna considers heart-lung transplantation medically necessary for persons with severe refractory heart failure plus either end-stage lung disease or irreversible pulmonary hypertension, when the selection criteria are met and no absolute contraindications are present. Examples of qualifying conditions include COPD with severe heart failure, cystic fibrosis with severe heart failure, congenital heart disease with pulmonary hypertension that is not amenable to lung transplantation and repair by standard cardiac surgery, and Eisenmenger's complex with irreversible pulmonary hypertension and severe heart failure. Heart-lung transplantation is considered not medically necessary where lung transplantation alone will restore right ventricular function.
Aetna's Clinical Policy Bulletin 0586 sets medical necessity criteria for heart transplantation and related services. Heart transplant is considered medically necessary for the listed indications, including cardiomyopathy, end-stage ventricular failure and congenital heart disease, when the member meets the transplanting institution's protocol eligibility criteria, and off protocol when all listed selection criteria are met. The policy also covers the FDA-approved total artificial heart as a bridge to transplant, AlloMap testing for rejection monitoring more than 2 months after transplant, and ex vivo heart perfusion for preservation and transport of the donor heart, and it lists several rejection tests and other procedures as experimental, investigational or unproven.
Aetna considers heart-lung transplantation medically necessary for persons with severe refractory heart failure plus either end-stage lung disease or irreversible pulmonary hypertension, when the selection criteria are met and no absolute contraindications are present. Heart-lung transplantation is considered not medically necessary where lung transplantation alone will restore right ventricular function, and every attempt should be made to preserve the heart. The member must meet the transplanting institution's selection criteria, and in the absence of those criteria, Aetna's listed criteria apply.
Aetna considers heart transplantation medically necessary when the member meets the transplanting institution's protocol eligibility criteria. Off protocol, all listed selection criteria must be met, including NYHA class III or IV heart failure (not required for pediatric members), life expectancy greater than 2 years in the absence of cardiovascular disease, and no absolute contraindications. The policy also covers the FDA-approved total artificial heart as a bridge to transplant for transplant-eligible members at imminent risk of death, covers AlloMap for rejection monitoring more than 2 months after transplant, and covers ex vivo heart perfusion for preservation and transport of the donor heart, while listing the total artificial heart as destination therapy and several rejection and graft tests as experimental, investigational, or unproven.
Independence Blue Cross reissued MA11.033c effective 09/30/2026 to reaffirm coverage for solid organ transplants (heart, lung, kidney, pancreas, liver, intestine, and multivisceral) under Medicare Advantage plans. The policy confirms that all transplant programs must maintain both Medicare and UNOS certification, and transplants must be performed at Medicare-approved facilities. No substantive coverage changes were made—this is a routine annual review reissuance.
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