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11.04.01e, Islet Cell Transplantation, including use of Donislecel-jujn (Lantidra)
Effective date
Feb 26, 2024
Identified
Jun 19, 2026
Summary
Independence Blue Cross reissued policy 11.04.01e to clarify that autologous islet cell transplantation remains covered only as an adjunct to total/near-total pancreatectomy for chronic pancreatitis, while allogeneic islet cell transplantation—including FDA-approved Lantidra (donislecel-jujn)—remains classified as experimental/investigational and is not covered. Billing teams must ensure claims for allogeneic islet transplants and Lantidra are denied, and only autologous procedures meeting specific criteria are processed for payment.
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What to do
Action · 4 steps
01By 02/26/2024 (already effective): Billing team must configure claims processing system to automatically deny all claims for allogeneic islet cell transplantation (CPT 0584T, 0585T, 0586T when documented as allogeneic; HCPCS S2102) with explanation of benefits stating 'experimental/investigational—not covered.' Configure system to deny all claims for Lantidra using HCPCS codes C9399, J3490, or J3590 with same denial message.
02For autologous islet cell transplants (CPT 0584T, 0585T, 0586T, 48160; HCPCS G0341, G0342, G0343), require documentation in claim submission verifying: (1) diagnosis of chronic pancreatitis (ICD-10 K86.0 or K86.1), (2) procedure is adjunct to total or near-total pancreatectomy, and (3) procedure is performed at facility capable of cell processing.
03Update claim review checklist to flag any Lantidra requests for immediate denial.
04Train billing staff that this policy applies to all commercial plans and remains in effect as of the most recent reissue (04/01/2026).
If missed: Failure to deny non-covered procedures may result in claim recoupment.
Codes mentioned
48160G0341G0342G0343S2102C9399J3490J3590K86.0K86.1Z90.410Z90.411
Original notice
11.04.01e, Islet Cell Transplantation, including use of Donislecel-jujn (Lantidra)
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
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