CommercialCoverageMedium impact
Pancreas Transplant: (Pancreas Transplant Alone, Pancreas Transplant after Kidney Transplant, Simultaneous Pancreas Kidney Transplant): Islet Cell Transplant 7.02.01
Excellus BlueCross BlueShield·Endocrinology, General Surgery, Nephrology +1 more·Transplants
Effective date
Mar 19, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their pancreas transplant policy effective March 19, 2026, establishing specific medical necessity criteria for pancreas transplant alone (PTA), pancreas after kidney transplant (PAK), and simultaneous pancreas-kidney transplant (SPK). The policy also classifies allogeneic pancreatic islet cell transplantation with Lantidra as investigational, while autologous islet cell transplantation remains medically appropriate as an adjunct to pancreatectomy for chronic pancreatitis.
Action Required
Before March 19, 2026: Billing team must review all pancreas transplant cases to ensure they meet the new medical necessity criteria outlined in the policy. Update prior authorization requests to include documentation of insulin-dependent diabetes mellitus with frequent acute metabolic complications and consistent failure of insulin management. Ensure providers document all required pre-transplant evaluation components including clinical, psychosocial, performance status, oral health, lab tests, cardiac and pulmonary assessments. Flag any allogeneic islet cell transplantation cases as investigational and likely not covered.