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Heart-Lung Transplantation (CPB 0597, reviewed 2025-12-02)
Effective date
Not stated in the notice
Identified
Aug 17, 2026
Summary
Aetna considers heart-lung transplantation medically necessary for persons with severe refractory heart failure plus either end-stage lung disease or irreversible pulmonary hypertension, when the selection criteria are met and no absolute contraindications are present. Heart-lung transplantation is considered not medically necessary where lung transplantation alone will restore right ventricular function, and every attempt should be made to preserve the heart. The member must meet the transplanting institution's selection criteria, and in the absence of those criteria, Aetna's listed criteria apply.
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What to do
Action · 3 steps
01REQUIREMENTS: Billing team: For CPT 33930 through 33945 and HCPCS S2054, S2055, S2060 and S2061, bill only for members who meet the transplanting institution's selection criteria.
02Where the institution has none, the member must meet all of Aetna's listed criteria: no chronic high-dose steroid therapy; no acute or chronic active infection that is not effectively treated; no malignancy other than non-melanomatous skin cancer or low-grade prostate cancer, unless completely resected or treated with small likelihood of recurrence; adequate functional status; bilirubin below 2.5 mg/dL and GFR above 40 mL/min/1.73 m2; life expectancy above 2 years; no active alcohol or chemical dependency and no uncontrolled psychiatric disorder that interferes with a strict treatment regimen; and, if HIV/AIDS is present, CD4 count above 200 cells/mm3 for more than 6 months, undetectable HIV-1 RNA, stable antiviral therapy for more than 3 months, and no other AIDS complications.
03Heart-lung transplantation is considered not medically necessary for members with contraindications including gastrointestinal disease such as bleeding peptic ulcer, diverticulitis, chronic hepatitis or active or recurrent pancreatitis; multi-system disease; other effective treatments or surgical options being available; progressive neuromuscular disease; refractory uncontrolled hypertension; severe musculoskeletal disease with debilitating thoracic involvement; smoking without at least 3 months of abstinence; and untreated or unstable cerebrovascular disease.
Codes mentioned
3393033945S2054S2055S2060S2061E84.0E84.9I25.10I25.9I26.01I127.9I42.0I43I50.1I50.9J40J47.9J84.10J84.89M32.0M35.9Q20.0Q28.9T86.20T86.298T86.30T86.19T86.810T86.819
Original notice
Heart-Lung Transplantation (CPB 0597, reviewed 2025-12-02)
aetna.com · Always check the source before changing claims.
Related changes
See all Aetna changes →Heart-Lung Transplantation (CPB 0597, reviewed 2026-09-08)MediumNo effective date · Medical PolicyLung Transplantation (CPB 0598, reviewed 2026-09-08)MediumNo effective date · Medical PolicyPalivizumab (Synagis) (CPB 0318, reviewed 2025-11-24)MediumNo effective date · Medical PolicyBrain Natriuretic Peptide Testing (CPB 0618, reviewed 2026-09-29)MediumNo effective date · Medical PolicyBrowse every Aetna change in the policy list
Related policy hubs
Aetna policiesCardiothoracic SurgeryTransplant SurgeryCardiologyPulmonologyCode 33930Code 33945Code S2054Code S2055Code S2060Code S2061Code E84.0Code E84.9Code I25.10Code I25.9Code I26.01Code I127.9Code I42.0Code I43Code I50.1Code I50.9Code J40Code J47.9Code J84.10Code J84.89Code M32.0Code M35.9Code Q20.0Code Q28.9Code T86.20Code T86.298Code T86.30Code T86.19Code T86.810Code T86.819