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Blue Cross & Blue Shield of MississippiAll Plans · Coverage · Medical Policy · MS · Transplant Surgery, GastroenterologyMedium impact

Isolated Small Bowel Transplant

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

Summary

Cadaveric small bowel transplant may be considered medically necessary for adult and pediatric individuals with intestinal failure who have established long-term dependence on total parenteral nutrition and are developing or have developed severe TPN complications. Living donor small bowel transplant may be considered medically necessary only when a cadaveric intestine is not available for an individual who meets the cadaveric criteria, and a small bowel retransplant may be considered medically necessary after a failed primary small bowel transplant. Small bowel transplant is considered investigational for adult and pediatric individuals with intestinal failure who are able to tolerate TPN, and living donor small bowel transplant is considered investigational in all other situations.

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What to do

Action · 4 steps
01Get prior authorization through case management from Blue Cross & Blue Shield of Mississippi before a covered transplant procedure, because no benefits are provided without it.
02Confirm the candidate meets the transplant criteria: adequate cardiopulmonary status, absence of active infection, no history of malignancy within 5 years of transplantation (excluding nonmelanomatous skin cancers), and documented patient compliance with medical management.
03Coverage is not provided for services funded by governmental, foundation or charitable grants, for organs sold rather than donated to the recipient, or for an artificial organ.
04HIV positivity is not an absolute contraindication, and each transplant center determines selection criteria for HIV-positive patients.

Codes mentioned

44132441334413544136447154472044721K91.2

Original notice

Isolated Small Bowel 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 →
Small Bowel/Liver and Multivisceral 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 policiesMS policy changesTransplant SurgeryGastroenterologyCode 44132Code 44133Code 44135Code 44136Code 44715Code 44720Code 44721Code K91.2

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