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Blue Cross & Blue Shield of MississippiAll Plans · Prior Auth · Medical Policy · Transplant Surgery, GastroenterologyMedium impact

Small Bowel/Liver and Multivisceral Transplant

Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

Small bowel/liver or multivisceral transplant may be considered medically necessary for pediatric and adult individuals with intestinal failure who have been managed with long-term total parenteral nutrition and have developed evidence of impending end-stage liver failure. Retransplantation after a failed primary small bowel/liver or multivisceral transplant may be considered medically necessary. The transplant is considered investigational in individuals with known current malignancy including metastatic cancer, recent malignancy with a high risk of recurrence, untreated systemic infection making immunosuppression unsafe, or other irreversible end-stage disease not attributed to intestinal failure.

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What to do

Action · 3 steps
01No benefits are provided for a covered transplant procedure or a transplant evaluation unless the member receives prior authorization through case management from Blue Cross & Blue Shield of Mississippi.
02Candidates should have adequate cardiopulmonary status and documentation of individual compliance with medical management.
03Coverage is not provided for services covered or funded by governmental, foundation, or charitable grants, for organs sold rather than donated to the recipient, or for an artificial organ.

Codes mentioned

01990441324413344135441364471544720447214713347135471404714147142471434714447145471464714747399S2053S2054S2055S2152K91.2

Original notice

Small Bowel/Liver and Multivisceral Transplant
bcbsms.com · Always check the source before changing claims.
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Related changes

See all Blue Cross & Blue Shield of Mississippi changes →
Liver Transplant and Combined Liver-Kidney TransplantMediumNo effective date · Medical PolicyIsolated Small Bowel TransplantMediumNo effective date · Medical PolicyAllogeneic Pancreas TransplantMediumNo effective date · Medical PolicyLung and Lobar Lung TransplantMediumNo effective date · Medical PolicyBrowse every Blue Cross & Blue Shield of Mississippi change in the policy list

Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesTransplant SurgeryGastroenterologyCode 01990Code 44132Code 44133Code 44135Code 44136Code 44715Code 44720Code 44721Code 47133Code 47135Code 47140Code 47141Code 47142Code 47143Code 47144Code 47145Code 47146Code 47147Code 47399Code S2053Code S2054Code S2055Code S2152Code K91.2

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