Autologous Islet Cell Transplant - MEDICAID - VIRGINIA (New)
Humana Medicaid in Virginia is introducing a new coverage policy (HUM-VA-2664-001) for autologous islet cell transplant (pancreatectomy with islet autotransplantation) effective 2026-10-28. The policy covers this procedure for members under 21 with chronic pancreatitis meeting strict clinical criteria, including intractable pain with impaired quality of life and failed prior interventions, while excluding candidates with active substance use, uncontrolled psychiatric illness, C-peptide negative diabetes, high-risk cardiopulmonary disease, pancreatic cancer, portal hypertension/thrombosis, significant liver disease, or Type 1 diabetes. Billing teams must recognize this new covered service and apply the specific eligibility criteria and CPT code (48160) for claim submission.