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47135

PAYER POLICY CHANGES

47135 Insurance Policy Changes

CPT 47135, in plain terms, covers A surgical procedure where a donor liver is placed into a patient to replace their diseased or failing liver. CPT 47135 is referenced in 8 tracked payer policy changes from Capital Blue Cross, 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 47135 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 47135 on AAPC

Capital Blue Cross · Identified Jun 20, 2026High impact
AB2026-01-003 Medical policies
Capital Blue Cross added preauthorization requirements for Keytruda Qlex (J9999) and Grafapex (J0614), and for new aflibercept, denosumab, IVIG and ustekinumab products under J3590, Q5157, J1599 and Q5137, with the changes effective March 1, 2026. Policy updates effective February 1, 2026 and March 1, 2026 also removed preauthorization for procedure code 48556 for commercial plans and for procedure codes 64596 and 64598 for commercial plans, and for procedure codes 64570 and L8681 for Medicare Advantage.
Excellus BlueCross BlueShield · Effective Mar 19, 2026Medium impact
Small Bowel and Multivisceral Transplants in Adults and Children 7.02.05
Excellus BlueCross BlueShield policy 07.02.05 covers small bowel (SB) transplant in pediatric and adult patients with short bowel syndrome for listed indications. These include impending or overt liver failure from TPN-induced liver injury, thrombosis of two or more central veins, two or more hospitalized episodes per year of line-related systemic sepsis, a single episode of line-related fungemia, septic shock or acute respiratory distress syndrome, and frequent episodes of severe dehydration despite IV fluids plus TPN. Multivisceral transplant is considered medically appropriate in pediatric and adult patients with intestinal failure and concurrent liver failure. SB transplant for patients with intestinal failure who can tolerate TPN, and SB transplant using live donor tissue, are considered investigational. Candidates must also meet listed criteria for cardiopulmonary status, absence of active infection, absence of malignancy, and documented compliance with medical management.
Excellus BlueCross BlueShield · Effective Nov 20, 2025Medium impact
Liver Transplantation 7.02.07
Excellus BlueCross BlueShield policy 7.02.07 covers liver transplantation for selected people with end-stage liver disease when criteria are met. Listed indications include alcoholic cirrhosis, viral hepatitis, autoimmune hepatitis, primary hepatocellular carcinoma when the disease is organ confined and the patient is not a candidate for subtotal liver resection, and familial amyloid polyneuropathy. Cadaver recipients need a MELD score of 9 or greater, and living donor recipients need a MELD score from 9 to 25, a listing on the cadaveric liver transplant waiting list, and at least one significant complication of liver disease. The current effective date is November 20, 2025, and the policy history records an annual review with the policy intent unchanged.
Aetna · Identified Oct 6, 2026Medium impact
Liver Transplantation (CPB 0596, reviewed 2026-09-08)
Aetna considers orthotopic liver transplantation medically necessary for members with end-stage liver disease from the listed conditions who meet the criteria below. Adolescents 12 years of age or older and adults qualify with a MELD score greater than 10, approval by the UNOS Regional Review Board, or when they meet the transplant institution's selection criteria, and children under 12 qualify when they meet the transplanting institution's selection criteria. Liver transplantation is not medically necessary for absolute contraindications including active sepsis outside the biliary tract, inability to adhere to the transplant regimen (including homelessness, active substance abuse, and unstable psychiatric disease or psychosocial problem), presence of other effective treatments or surgical options, and significant organ system failure other than kidney, liver or small bowel.
Aetna · Identified Aug 19, 2026Medium impact
Intestinal Transplantation (CPB 0605, reviewed 2025-09-10)
Aetna considers intestinal transplantation medically necessary for persons with clinical indicators of failed total parenteral nutrition (TPN) who meet the selection criteria. The selection criteria include absence of acute or chronic active infections that are not effectively treated, an ejection fraction greater than or equal to 40%, a bilirubin of less than 2.5 mg/dL, a creatinine clearance greater than 50 mL/min/kg, and controlled HIV/AIDS. Intestinal transplant is considered not medically necessary for persons with contraindications such as refractory heart failure with an ejection fraction less than 40%, untreated malignancy, multi-organ failure, sepsis, or inability to adhere to the transplant regimen, including homelessness, active substance abuse, or unstable psychiatric disease.
Aetna · Identified Aug 19, 2026Medium impact
Liver Transplantation (CPB 0596, reviewed 2026-03-02)
Aetna considers orthotopic liver transplantation medically necessary for members with end-stage liver disease from the listed conditions who meet the policy's medical necessity criteria. For adolescents 12 or older and adults, the criteria are a MELD score greater than 10, approval by a UNOS Regional Review Board, or meeting the transplant institution's selection criteria. Children under 12 are covered when they meet the transplanting institution's selection criteria. The policy also covers primary hepatocellular carcinoma confined to the liver that meets listed criteria, retransplantation after a failed transplant performed for a covered indication, normothermic machine perfusion of the transplanted liver, and compatibility testing for living donors. Absolute contraindications include active sepsis outside the biliary tract, inability to adhere to the transplant regimen, and significant organ system failure other than kidney, liver or small bowel failure. Liver transplantation for malignancies other than those listed, and several perfusion, biomarker and support-system uses, are described as experimental, investigational or unproven.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Small Bowel/Liver and Multivisceral Transplant
Small bowel/liver or multivisceral transplant may be considered medically necessary for pediatric and adult individuals with intestinal failure who have been managed with long-term total parenteral nutrition and have developed evidence of impending end-stage liver failure. Retransplantation after a failed primary small bowel/liver or multivisceral transplant may be considered medically necessary. The transplant is considered investigational in individuals with known current malignancy including metastatic cancer, recent malignancy with a high risk of recurrence, untreated systemic infection making immunosuppression unsafe, or other irreversible end-stage disease not attributed to intestinal failure.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Liver Transplant and Combined Liver-Kidney Transplant
Blue Cross Blue Shield of Mississippi updated its liver transplant policy on 04/09/2026. The medically necessary criteria now list metabolic dysfunction-associated steatohepatitis (MASH) in place of non-alcoholic steatohepatitis, and liver transplant for hepatic adenoma, unresectable colorectal liver metastases, and epithelioid hemangioendothelioma (HEHE) is investigational. No benefits are provided for a covered transplant procedure unless the member receives prior authorization through case management from this plan.

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REFERENCE DATA

Payers with rules23

Payers requiring prior auth23

Anthem BCBS · Effective November 1, 2026
Prior authorization required
Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial)
Blue Shield of California · Effective November 1, 2026
Prior authorization required
Prior Authorization List for Blue Shield Medicare
BCBS Michigan · Effective October 13, 2026
Prior authorization required in some cases
BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines)

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for 47135?

Ambetter lists 47135 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does AmeriHealth Caritas require prior authorization for 47135?

AmeriHealth Caritas lists 47135 on AmeriHealth Caritas Louisiana prior authorization service list for medicaid managed plans. Verify with the payer before scheduling.

Does Anthem BCBS require prior authorization for 47135?

Anthem BCBS lists 47135 on Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial) for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does Arizona Complete Health require prior authorization for 47135?

Arizona Complete Health lists 47135 on Arizona Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does BCBS Arizona require prior authorization for 47135?

BCBS Arizona lists 47135 on AZ Blue Standard Prior Authorization Requirements Code List (Updated 10/01/2026) for commercial plans (list dated October 1, 2026). Verify with the payer before scheduling.

What insurance policy changes affect CPT 47135?

There are 8 tracked policy changes affecting CPT 47135, including updates from Capital Blue Cross, Excellus BlueCross BlueShield, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 47135?

Payers that have issued tracked updates for CPT 47135 include: Capital Blue Cross, Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when CPT 47135 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 47135. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for CPT 47135?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

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All billing codes J3590 C9399 J3490 99215 99213 99202

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AB2026-01-003 Medical policies

Small Bowel and Multivisceral Transplants in Adults and Children 7.02.05

Liver Transplantation 7.02.07

Liver Transplantation (CPB 0596, reviewed 2026-09-08)

Intestinal Transplantation (CPB 0605, reviewed 2025-09-10)

Liver Transplantation (CPB 0596, reviewed 2026-03-02)

Small Bowel/Liver and Multivisceral Transplant

Liver Transplant and Combined Liver-Kidney Transplant

Prior authorization required