High impact
Liver Transplantation (CPB 0596, reviewed 2026-03-02)
Aetna·Effective Mar 2, 2026
Aetna has updated its Liver Transplantation policy (CPB 0596, effective 2026-03-02) establishing medical necessity criteria for liver transplant coverage based on MELD scores, UNOS approval, and institutional selection criteria. The policy specifies covered indications (cholestatic diseases, hepatocellular diseases, malignancies, vascular diseases, metabolic disorders, and miscellaneous conditions), lists absolute contraindications including active substance abuse with exceptions for documented 3-month stability, and designates numerous interventions as experimental/investigational. Billing teams must immediately implement prior authorization requirements and validate claims against the specified covered indications and contraindications.