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MA11.007b, Islet Cell Transplantation, including use of Donislecel-jujn (Lantidra)
Act
by Mar 31, 2025
Effective date
Feb 26, 2024
Identified
Jun 19, 2026
Summary
Independence Blue Cross Medicare Advantage reissued policy MA11.007b on islet cell transplantation with minor updates. Autologous islet cell transplantation remains covered only as an adjunct to total/near-total pancreatectomy for chronic pancreatitis. Allogeneic islet cell transplantation, including FDA-approved donislecel-jujn (Lantidra), remains classified as experimental/investigational and is not covered. Three HCPCS codes (C9399, J3490, J3590) are designated for Lantidra representation.
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What to do
by Mar 31, 2025 · 7 steps
01Billing team must ensure claims systems reflect current policy status.
02For Medicare Advantage members.
03Continue allowing coverage for CPT codes 0584T, 0585T, 0586T, 48160, and HCPCS codes G0341, G0342, G0343 ONLY when autologous islet cell transplant is performed as adjunct to pancreatectomy for chronic pancreatitis (ICD-10: K86.0, K86.1, Z90.410, Z90.411).
04Do NOT cover allogeneic islet cell transplantation claims using CPT codes 0584T, 0585T, 0586T, HCPCS S2102, or drug codes C9399, J3490, J3590 for donislecel-jujn (Lantidra) - deny as experimental/investigational.
05Update denial templates to reference experimental/investigational status for allogeneic transplant requests.
06Flag any Lantidra claims (C9399, J3490, J3590) for automatic denial unless member is enrolled in NIH-sponsored clinical trial.
07Document trial participation in claim notes before processing.
If missed: Failure to implement will result in improper payment for non-covered allogeneic procedures.
Codes mentioned
48160G0341G0342G0343S2102C9399J3490J3590K86.0K86.1Z90.410Z90.411
Original notice
MA11.007b, 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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