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Excellus BlueCross BlueShieldAll Plans · Coverage · Transplants · NY · Transplant Surgery, GastroenterologyMedium impact

Liver Transplantation 7.02.07

Effective date
Nov 20, 2025
Identified
Jun 20, 2026

Summary

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.

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What to do

Action · 7 steps
01REQUIREMENTS: Prior authorization is contract dependent, and approvals for all transplants, including arrangements with an approved transplant center, may be required.
02Pre-transplant evaluation documentation could include confirmation of diagnosis, comorbidities and their treatment, consult notes, a Karnofsky or Palliative Performance Scale score, identification of stressors, an oral health evaluation, a CBC and metabolic profile, CMV and hepatitis B and C serologies, HIV testing, a 12 lead EKG, stress testing, an echo or MUGA scan, a chest x-ray, pulmonary function tests for high-risk patients, and a low dose screening CT for high-risk lung cancer patients.
03If a test cannot be performed, the documentation must include the rationale.
04Re-authorization must be completed annually while the patient is actively waiting for a transplant, with documentation from within the past 11 months unless specified, including updated diagnoses and treatment plan, a current Karnofsky or Palliative Performance Scale score, a follow-up oral health evaluation, a CBC and metabolic profile, CMV and hepatitis B and C serologies, and HIV testing if applicable.
05For candidates with end-stage disease related to or impacted by alcohol consumption, including viral hepatitis, abstinence must be shown through clinical treatment records such as primary care or alcohol treatment program records.
06If abstinence has lasted less than one month, a medical director consultation with the transplant center behavioral health team is required, including an assessment by a trained Alcohol and Addiction Professional.
07For candidates listed at more than one transplant center, test results used at one center should be used at subsequent centers when possible.

Codes mentioned

47133471354714047141471424714347144471454714647147A52.15B25.1B66.1B66.3C22.0D81.810D84.1E74.39E88.89E88.9G60.0G60.2G63I82.0I99.9K74.0K75.9K76.4K77K87M34.83Q44.6S31.609AS36.112A

Original notice

Liver Transplantation 7.02.07
excellusbcbs.com · Always check the source before changing claims.
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Related changes

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Lung and Lobar Lung Transplant 7.02.10MediumEffective Apr 16, 2026 · TransplantsStereotactic Radiosurgery and Stereotactic Body Radiation Therapy 6.01.12MediumEffective Nov 16, 2025 · Radiation TreatmentRadioembolization (TARE) for Hepatic Tumors 7.01.69MediumEffective Feb 19, 2026 · Radiation TreatmentSmall Bowel and Multivisceral Transplants in Adults and Children 7.02.05MediumEffective Mar 19, 2026 · TransplantsBrowse every Excellus BlueCross BlueShield change in the policy list

Related policy hubs

Excellus BlueCross BlueShield policiesNY policy changesTransplant SurgeryGastroenterologyCode 47133Code 47135Code 47140Code 47141Code 47142Code 47143Code 47144Code 47145Code 47146Code 47147Code A52.15Code B25.1Code B66.1Code B66.3Code C22.0Code D81.810Code D84.1Code E74.39Code E88.89Code E88.9Code G60.0Code G60.2Code G63Code I82.0Code I99.9Code K74.0Code K75.9Code K76.4Code K77Code K87Code M34.83Code Q44.6Code S31.609ACode S36.112A

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