Intestinal Transplantation (CPB 0605, reviewed 2025-09-10)

By September 24, 2025: Billing and clinical teams must implement the following: (1) Update authorization systems to require verification of all selection criteria before approving intestinal transplant claims (CPT 44135, 44136, S2053, S2054) — specifically documented ejection fraction ≥40%, bilirubin <2.5 mg/dL, creatinine clearance >50 ml/min/kg, and absence of active untreated infections; (2) Configure billing system to flag claims with ICD-10 codes B18.0, B18.1, B18.2, or C78.6 as non-covered (contraindications); (3) Develop pre-authorization checklist requiring providers to document TPN failure indicators (liver failure, thrombosis of 2+ central veins, 2+ sepsis episodes per year, or severe dehydration despite supplementation); (4) Update encounter forms and EMR templates to capture HIV status (CD4 >200 cells/mm³ for 6+ months, undetectable viral load, stable antivirals 3+ months) for eligible candidates; (5) Train billing staff to identify multi-visceral transplant candidates (S2054) who need combined small bowel/liver evaluation and require measured GFR (not calculated) for renal assessment; (6) Deny claims for fecal calprotectin testing (CPT 83993) as it remains experimental for intestinal allograft rejection assessment; (7) Communicate policy to all providers and transplant coordinators. Failure to obtain proper authorization and documentation will result in claim denials.