Prior Authorization : Services Requiring Prior Authorization

Transplant Services

Hospitals are required to obtain PA for the following transplants:

• Bone marrow (including peripheral blood stem cell transplantation)
• Hematopietic stem cell (including cord blood stem cell transplantation)
• Other transplants not listed above

For all transplants requiring PA, the hospital and the transplant physician are encouraged to jointly complete and submit a PA/RF and PA/PA, including relevant patient information with the PA request.

Hospitals are not required to obtain PA for the following solid organ transplants:

• Cornea
• Heart
• Kidney
• Liver
• Lung
• Pancreas
• Small bowel

Transplants involving combinations of the above organs (for example, heart-lung) also do not require PA.

In cases of multiple organ transplants where no single CPT code describes the procedure performed, the provider should indicate each individual procedure code, if available, on the PA request.