CommercialCoverageMedium impact
11.04.01e, Islet Cell Transplantation, including use of Donislecel-jujn (Lantidra)
Independence Blue Cross·Transplant Surgery, Endocrinology·Medical Policy
Effective date
Mar 5, 2025
We identified it
Jun 19, 2026
Summary
Policy 11.04.01e on Islet Cell Transplantation, including the new drug Donislecel-jujn (Lantidra), was reissued effective March 5, 2025. This recent policy update establishes coverage guidelines and billing requirements for islet cell transplant procedures and the newly FDA-approved Lantidra product. Billing teams must review the full policy text to identify specific coverage criteria, prior authorization requirements, and applicable billing codes.
Action Required
By March 31, 2025: Billing and clinical teams must obtain and review the complete policy text for 11.04.01e at the provided URL to identify: (1) specific CPT/HCPCS codes for islet cell transplantation and Donislecel-jujn administration, (2) prior authorization requirements and submission process, (3) medical necessity criteria for coverage, and (4) any documentation requirements. Update billing system templates, prior auth workflows, and provider communications accordingly. Ensure all staff involved in transplant billing and authorization are trained on new requirements before April 1, 2025. Claims submitted without adherence to this policy may be denied.