All PlansCoverageMedium impact
Lung and Lobar Lung Transplant 7.02.10
Excellus BlueCross BlueShield·Pulmonology, Cardiothoracic Surgery, Critical Care·Transplants
Effective date
Apr 16, 2026
We identified it
Jun 20, 2026
Summary
New lung and lobar lung transplant policy 7.02.10 effective April 16, 2026, establishes comprehensive medical criteria for transplant eligibility and requires extensive pre-transplant evaluation documentation. The policy includes specific contraindications for HIV-positive patients and detailed recipient selection guidelines.
Action Required
By April 16, 2026: Billing teams must ensure prior authorization requirements are met for all lung transplant cases (contract dependent). Update documentation requirements to include comprehensive pre-transplant evaluations with clinical assessment, psychosocial evaluation, performance status scores, oral health evaluation, complete lab panel, cardiac and pulmonary assessments, and age-appropriate screenings. Implement annual reauthorization process for patients on transplant waiting lists using same criteria.