Aetna · Clinical coverage policy

Aetna Heart Transplantation coverage criteria

Aetna covers heart transplantation as medically necessary for irreversible end-stage heart disease (e.g., cardiomyopathy, congenital heart disease, intractable coronary artery disease, valvular disease, re-transplant for graft failure) when the member meets the transplant center's protocol; off-protocol, the member must meet ALL selection criteria (including NYHA Class III/IV for adults, life expectancy >2 years, adequate organ function, controlled HIV, no active malignancy/infection/substance dependency) and have none of the listed absolute contraindications. An FDA-approved total artificial heart is covered only as a bridge to transplant, and the AlloMap test is covered for rejection monitoring beyond 2 months post-transplant; destination-therapy artificial hearts and numerous rejection-detection assays (e.g., donor-derived cell-free DNA/Prospera/Allosure, MMDx-Heart, myTAIHEART, cardiac xenotransplantation) are experimental/investigational.

Policy CPB 0586 · Effective · Verify against the current Aetna policy before submitting — view source policy.

Payer

Aetna

Policy

CPB 0586

Prior auth

Confirm

Effective

January 1, 2026

This page reflects the coverage criteria captured from Aetna policy CPB 0586 and may not include every criterion, exception, or code — verify the complete bulletin before submitting.

What this means for the claim

The covered path, the next step to get it approved, and the specific way it denies — built only from this policy.

When does Aetna cover Heart Transplantation (CPT 33945), and what gets it denied?

Path
Aetna covers heart transplantation as medically necessary for irreversible end-stage heart disease (e.g., cardiomyopathy, congenital heart disease, intractable coronary artery disease, valvular disease, re-transplant for graft failure) when the member meets the transplant center's protocol; off-protocol, the member must meet ALL selection criteria (including NYHA Class III/IV for adults, life expectancy >2 years, adequate organ function, controlled HIV, no active malignancy/infection/substance dependency) and have none of the listed absolute contraindications. An FDA-approved total artificial heart is covered only as a bridge to transplant, and the AlloMap test is covered for rejection monitoring beyond 2 months post-transplant; destination-therapy artificial hearts and numerous rejection-detection assays (e.g., donor-derived cell-free DNA/Prospera/Allosure, MMDx-Heart, myTAIHEART, cardiac xenotransplantation) are experimental/investigational. Coverage criteria include: Heart transplantation is considered medically necessary for ANY of the following conditions (not an all-inclusive list) WHEN the member meets the transplanting institution's protocol eligibility criteria.; In the ABSENCE of a protocol, heart transplantation is medically necessary for heart failure with irreversible underlying etiology, including the listed indications, ONLY WHEN ALL the Selection Criteria are met AND none of the absolute Contraindications is present.; Covered indication (off-protocol, selection criteria met, no contraindication): Cardiac arrhythmia.; Covered indication: Cardiac re-transplantation due to graft failure.; Covered indication: Cardiomyopathy due to nutritional, metabolic, hypertrophic or restrictive etiologies.; Covered indication: Congenital heart disease.; Covered indication: End-stage ventricular failure.; Covered indication: Idiopathic dilated cardiomyopathy.; Covered indication: Inability to be weaned from temporary cardiac-assist devices after myocardial infarction or non-transplant cardiac surgery.; Covered indication: Intractable coronary artery disease.; Covered indication: Myocarditis.; Covered indication: Post-partum cardiomyopathy.; Covered indication: Right ventricular dysplasia/cardiomyopathy.; Covered indication: Valvular heart disease.; Selection Criteria for off-protocol members (must meet ALL of the following): see the individual criteria below.; Selection criterion (ALL of): New York Heart Association (NYHA) classification of heart failure III or IV — DOES NOT APPLY to pediatric members. (NYHA Class III = cardiac disease with marked limitation of physical activity, comfortable at rest, less than ordinary activity causes fatigue/palpitation/dyspnea/anginal pain; NYHA Class IV = inability to carry on any physical activity without discomfort, symptoms may be present even at rest.); Selection criterion (ALL of): Member has potential for conditioning and rehabilitation after transplant (i.e., member is not moribund).; Selection criterion (ALL of): Life expectancy (in the absence of cardiovascular disease) is greater than 2 years.; Selection criterion (ALL of): No malignancy — EXCEPT non-melanomatous skin cancers OR low grade prostate cancer; OR malignancy has been completely resected; OR (upon individual case review) malignancy has been adequately treated with no substantial likelihood of recurrence with acceptable future risks.; Selection criterion (ALL of): Adequate pulmonary, liver and renal function.; Selection criterion (ALL of): Absence of active infections that are not effectively treated.; Selection criterion (ALL of): Absence of uncontrolled HIV infection, defined as ALL of — CD4 count greater than 200 cells/mm3 for greater than 6 months; AND HIV-1 RNA (viral load) undetectable; AND on stable anti-viral therapy greater than 3 months; AND no other complications from AIDS such as opportunistic infections (e.g., aspergillus, tuberculosis, coccidiodomycosis, resistant fungal infections) or neoplasms (e.g., Kaposi's sarcoma, non-Hodgkin's lymphoma).; Selection criterion (ALL of): Absence of active or recurrent pancreatitis.; Selection criterion (ALL of): Absence of diabetes with severe end-organ damage (neuropathy, nephropathy with declining renal function and proliferative retinopathy).; Selection criterion (ALL of): No uncontrolled and/or untreated psychiatric disorders that interfere with compliance to a strict treatment regimen.; Selection criterion (ALL of): No active alcohol or chemical dependency that interferes with compliance to a strict treatment regimen.; Total Artificial Heart — a U.S. FDA-approved total artificial heart (e.g., CardioWest Total Artificial Heart, SynCardia Systems) is medically necessary WHEN used as a BRIDGE TO TRANSPLANT for transplant-eligible members who are at imminent risk of death (NYHA Class IV) due to biventricular failure who are awaiting heart transplantation. (See CPB 0654 - Ventricular Assist Devices.); AlloMap molecular-expression blood test (AlloMap gene expression profile) is medically necessary for MONITORING REJECTION in heart transplant recipients more than 2 months post-heart transplant. (See Appendix for recommended interval frequency of AlloMap and AlloSure Heart testing for surveillance.). Applies to 3 codes: 33945, 33940, 33935.
Action
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
Trap
Policy exclusions and limitations: Contraindication (heart transplant NOT medically necessary if ANY present): Presence of irreversible end-organ diseases (e.g., renal, hepatic, pulmonary) — UNLESS person is to undergo dual organ transplantation (e.g., heart-lung, heart-kidney, etc.).; Contraindication (NOT medically necessary if present): Presence of severe pulmonary hypertension with irreversibly high pulmonary vascular resistance.; Contraindication (NOT medically necessary if present): Presence of a recent intra-cranial cerebrovascular event with significant persistent deficit.; Contraindication (NOT medically necessary if present): Presence of bleeding peptic ulcer.; Contraindication (NOT medically necessary if present): Presence of hepatitis B antigen.; Contraindication (NOT medically necessary if present): Presence of diverticulitis.; Contraindication (NOT medically necessary if present): Presence of immediately life-threatening neuromuscular disorders.; Contraindication (NOT medically necessary if present): Presence of HIV/AIDS with profound immunosuppression (CD4 count of less than 200 cells/mm3).; Contraindication (NOT medically necessary if present): Presence of AL amyloidosis — EXCEPTION may be made where curative therapy of amyloidosis has been performed or is planned (e.g., stem cell transplantation in primary amyloidosis, liver transplantation in familial amyloidosis).; Experimental, investigational, or unproven: Total artificial heart (e.g., ABIOCOR Total Artificial Heart, SynCardia temporary Total Artificial Heart, formerly CardioWest Total Artificial Heart) as PERMANENT treatment (destination therapy) / alternative to heart transplantation — safety and effectiveness not established.; Experimental, investigational, or unproven: AlloMap gene expression profile for ALL OTHER indications (other than monitoring rejection more than 2 months post-transplant) — clinical value not established.; Experimental, investigational, or unproven: Xenotransplantation of the heart — cardiac xenotransplantation (e.g., porcine xenografts).; Experimental, investigational, or unproven: Heartsbreath Test (Menassana Research, Inc) for diagnosing heart transplant rejection and for all other indications.; Experimental, investigational, or unproven: Cytokine gene polymorphism testing for evaluating graft rejection following heart transplantation.; Experimental, investigational, or unproven: Immune repertoire sequencing assay for measurement of the isotype and clonal composition of the circulating B cell repertoire to detect acute allograft rejection in heart transplant recipients.; Experimental, investigational, or unproven: myTAIHEART test (TAI Diagnostics, Inc., Milwaukee, WI) for evaluating graft rejection following heart transplant and all other indications.; Experimental, investigational, or unproven: Measurement of cardiac troponins for diagnosis of acute cellular rejection following heart transplantation, and for assessing prognosis of primary graft failure in heart transplant recipients.; Experimental, investigational, or unproven: Measurement of donor-derived cell-free DNA (Allosure, Prospera Test) of transplant recipients for monitoring of rejection.; Experimental, investigational, or unproven: Measurement of pulmonary artery size as a predictor of early post-operative heart transplantation outcomes.; Experimental, investigational, or unproven: Heart Molecular Microscope Diagnostic System (MMDx-Heart) for evaluation of cardiac transplant rejection.; Experimental, investigational, or unproven: TransMedics Organ Care System for preservation and transport of donor heart.; Experimental, investigational, or unproven: The use of machine learning and artificial intelligence in cardiac transplantation.; Experimental, investigational, or unproven: The Prospera Heart test for detection of acute rejection, including antibody-mediated rejection (AMR) and acute cellular rejection (ACR) in heart transplantation. Claims may be denied when the requested service falls under these. Some of these are conditional (note the stated exceptions) — confirm specifics against the bulletin.

Source: Aetna CPB 0586 — Heart Transplantation

Coverage criteria

  • Heart transplantation is considered medically necessary for ANY of the following conditions (not an all-inclusive list) WHEN the member meets the transplanting institution's protocol eligibility criteria.
  • In the ABSENCE of a protocol, heart transplantation is medically necessary for heart failure with irreversible underlying etiology, including the listed indications, ONLY WHEN ALL the Selection Criteria are met AND none of the absolute Contraindications is present.
  • Covered indication (off-protocol, selection criteria met, no contraindication): Cardiac arrhythmia.
  • Covered indication: Cardiac re-transplantation due to graft failure.
  • Covered indication: Cardiomyopathy due to nutritional, metabolic, hypertrophic or restrictive etiologies.
  • Covered indication: Congenital heart disease.
  • Covered indication: End-stage ventricular failure.
  • Covered indication: Idiopathic dilated cardiomyopathy.
  • Covered indication: Inability to be weaned from temporary cardiac-assist devices after myocardial infarction or non-transplant cardiac surgery.
  • Covered indication: Intractable coronary artery disease.
  • Covered indication: Myocarditis.
  • Covered indication: Post-partum cardiomyopathy.
  • Covered indication: Right ventricular dysplasia/cardiomyopathy.
  • Covered indication: Valvular heart disease.
  • Selection Criteria for off-protocol members (must meet ALL of the following): see the individual criteria below.
  • Selection criterion (ALL of): New York Heart Association (NYHA) classification of heart failure III or IV — DOES NOT APPLY to pediatric members. (NYHA Class III = cardiac disease with marked limitation of physical activity, comfortable at rest, less than ordinary activity causes fatigue/palpitation/dyspnea/anginal pain; NYHA Class IV = inability to carry on any physical activity without discomfort, symptoms may be present even at rest.)
  • Selection criterion (ALL of): Member has potential for conditioning and rehabilitation after transplant (i.e., member is not moribund).
  • Selection criterion (ALL of): Life expectancy (in the absence of cardiovascular disease) is greater than 2 years.
  • Selection criterion (ALL of): No malignancy — EXCEPT non-melanomatous skin cancers OR low grade prostate cancer; OR malignancy has been completely resected; OR (upon individual case review) malignancy has been adequately treated with no substantial likelihood of recurrence with acceptable future risks.
  • Selection criterion (ALL of): Adequate pulmonary, liver and renal function.
  • Selection criterion (ALL of): Absence of active infections that are not effectively treated.
  • Selection criterion (ALL of): Absence of uncontrolled HIV infection, defined as ALL of — CD4 count greater than 200 cells/mm3 for greater than 6 months; AND HIV-1 RNA (viral load) undetectable; AND on stable anti-viral therapy greater than 3 months; AND no other complications from AIDS such as opportunistic infections (e.g., aspergillus, tuberculosis, coccidiodomycosis, resistant fungal infections) or neoplasms (e.g., Kaposi's sarcoma, non-Hodgkin's lymphoma).
  • Selection criterion (ALL of): Absence of active or recurrent pancreatitis.
  • Selection criterion (ALL of): Absence of diabetes with severe end-organ damage (neuropathy, nephropathy with declining renal function and proliferative retinopathy).
  • Selection criterion (ALL of): No uncontrolled and/or untreated psychiatric disorders that interfere with compliance to a strict treatment regimen.
  • Selection criterion (ALL of): No active alcohol or chemical dependency that interferes with compliance to a strict treatment regimen.
  • Total Artificial Heart — a U.S. FDA-approved total artificial heart (e.g., CardioWest Total Artificial Heart, SynCardia Systems) is medically necessary WHEN used as a BRIDGE TO TRANSPLANT for transplant-eligible members who are at imminent risk of death (NYHA Class IV) due to biventricular failure who are awaiting heart transplantation. (See CPB 0654 - Ventricular Assist Devices.)
  • AlloMap molecular-expression blood test (AlloMap gene expression profile) is medically necessary for MONITORING REJECTION in heart transplant recipients more than 2 months post-heart transplant. (See Appendix for recommended interval frequency of AlloMap and AlloSure Heart testing for surveillance.)

Covered codes

Codes listed in this Aetna policy. Check each one's prior-authorization verdict and Medicare rate:

Frequently asked questions

When does Aetna cover Heart Transplantation (CPT 33945), and what gets it denied?
Aetna covers heart transplantation as medically necessary for irreversible end-stage heart disease (e.g., cardiomyopathy, congenital heart disease, intractable coronary artery disease, valvular disease, re-transplant for graft failure) when the member meets the transplant center's protocol; off-protocol, the member must meet ALL selection criteria (including NYHA Class III/IV for adults, life expectancy >2 years, adequate organ function, controlled HIV, no active malignancy/infection/substance dependency) and have none of the listed absolute contraindications. An FDA-approved total artificial heart is covered only as a bridge to transplant, and the AlloMap test is covered for rejection monitoring beyond 2 months post-transplant; destination-therapy artificial hearts and numerous rejection-detection assays (e.g., donor-derived cell-free DNA/Prospera/Allosure, MMDx-Heart, myTAIHEART, cardiac xenotransplantation) are experimental/investigational. Coverage criteria include: Heart transplantation is considered medically necessary for ANY of the following conditions (not an all-inclusive list) WHEN the member meets the transplanting institution's protocol eligibility criteria.; In the ABSENCE of a protocol, heart transplantation is medically necessary for heart failure with irreversible underlying etiology, including the listed indications, ONLY WHEN ALL the Selection Criteria are met AND none of the absolute Contraindications is present.; Covered indication (off-protocol, selection criteria met, no contraindication): Cardiac arrhythmia.; Covered indication: Cardiac re-transplantation due to graft failure.; Covered indication: Cardiomyopathy due to nutritional, metabolic, hypertrophic or restrictive etiologies.; Covered indication: Congenital heart disease.; Covered indication: End-stage ventricular failure.; Covered indication: Idiopathic dilated cardiomyopathy.; Covered indication: Inability to be weaned from temporary cardiac-assist devices after myocardial infarction or non-transplant cardiac surgery.; Covered indication: Intractable coronary artery disease.; Covered indication: Myocarditis.; Covered indication: Post-partum cardiomyopathy.; Covered indication: Right ventricular dysplasia/cardiomyopathy.; Covered indication: Valvular heart disease.; Selection Criteria for off-protocol members (must meet ALL of the following): see the individual criteria below.; Selection criterion (ALL of): New York Heart Association (NYHA) classification of heart failure III or IV — DOES NOT APPLY to pediatric members. (NYHA Class III = cardiac disease with marked limitation of physical activity, comfortable at rest, less than ordinary activity causes fatigue/palpitation/dyspnea/anginal pain; NYHA Class IV = inability to carry on any physical activity without discomfort, symptoms may be present even at rest.); Selection criterion (ALL of): Member has potential for conditioning and rehabilitation after transplant (i.e., member is not moribund).; Selection criterion (ALL of): Life expectancy (in the absence of cardiovascular disease) is greater than 2 years.; Selection criterion (ALL of): No malignancy — EXCEPT non-melanomatous skin cancers OR low grade prostate cancer; OR malignancy has been completely resected; OR (upon individual case review) malignancy has been adequately treated with no substantial likelihood of recurrence with acceptable future risks.; Selection criterion (ALL of): Adequate pulmonary, liver and renal function.; Selection criterion (ALL of): Absence of active infections that are not effectively treated.; Selection criterion (ALL of): Absence of uncontrolled HIV infection, defined as ALL of — CD4 count greater than 200 cells/mm3 for greater than 6 months; AND HIV-1 RNA (viral load) undetectable; AND on stable anti-viral therapy greater than 3 months; AND no other complications from AIDS such as opportunistic infections (e.g., aspergillus, tuberculosis, coccidiodomycosis, resistant fungal infections) or neoplasms (e.g., Kaposi's sarcoma, non-Hodgkin's lymphoma).; Selection criterion (ALL of): Absence of active or recurrent pancreatitis.; Selection criterion (ALL of): Absence of diabetes with severe end-organ damage (neuropathy, nephropathy with declining renal function and proliferative retinopathy).; Selection criterion (ALL of): No uncontrolled and/or untreated psychiatric disorders that interfere with compliance to a strict treatment regimen.; Selection criterion (ALL of): No active alcohol or chemical dependency that interferes with compliance to a strict treatment regimen.; Total Artificial Heart — a U.S. FDA-approved total artificial heart (e.g., CardioWest Total Artificial Heart, SynCardia Systems) is medically necessary WHEN used as a BRIDGE TO TRANSPLANT for transplant-eligible members who are at imminent risk of death (NYHA Class IV) due to biventricular failure who are awaiting heart transplantation. (See CPB 0654 - Ventricular Assist Devices.); AlloMap molecular-expression blood test (AlloMap gene expression profile) is medically necessary for MONITORING REJECTION in heart transplant recipients more than 2 months post-heart transplant. (See Appendix for recommended interval frequency of AlloMap and AlloSure Heart testing for surveillance.). Applies to 3 codes: 33945, 33940, 33935. Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Policy exclusions and limitations: Contraindication (heart transplant NOT medically necessary if ANY present): Presence of irreversible end-organ diseases (e.g., renal, hepatic, pulmonary) — UNLESS person is to undergo dual organ transplantation (e.g., heart-lung, heart-kidney, etc.).; Contraindication (NOT medically necessary if present): Presence of severe pulmonary hypertension with irreversibly high pulmonary vascular resistance.; Contraindication (NOT medically necessary if present): Presence of a recent intra-cranial cerebrovascular event with significant persistent deficit.; Contraindication (NOT medically necessary if present): Presence of bleeding peptic ulcer.; Contraindication (NOT medically necessary if present): Presence of hepatitis B antigen.; Contraindication (NOT medically necessary if present): Presence of diverticulitis.; Contraindication (NOT medically necessary if present): Presence of immediately life-threatening neuromuscular disorders.; Contraindication (NOT medically necessary if present): Presence of HIV/AIDS with profound immunosuppression (CD4 count of less than 200 cells/mm3).; Contraindication (NOT medically necessary if present): Presence of AL amyloidosis — EXCEPTION may be made where curative therapy of amyloidosis has been performed or is planned (e.g., stem cell transplantation in primary amyloidosis, liver transplantation in familial amyloidosis).; Experimental, investigational, or unproven: Total artificial heart (e.g., ABIOCOR Total Artificial Heart, SynCardia temporary Total Artificial Heart, formerly CardioWest Total Artificial Heart) as PERMANENT treatment (destination therapy) / alternative to heart transplantation — safety and effectiveness not established.; Experimental, investigational, or unproven: AlloMap gene expression profile for ALL OTHER indications (other than monitoring rejection more than 2 months post-transplant) — clinical value not established.; Experimental, investigational, or unproven: Xenotransplantation of the heart — cardiac xenotransplantation (e.g., porcine xenografts).; Experimental, investigational, or unproven: Heartsbreath Test (Menassana Research, Inc) for diagnosing heart transplant rejection and for all other indications.; Experimental, investigational, or unproven: Cytokine gene polymorphism testing for evaluating graft rejection following heart transplantation.; Experimental, investigational, or unproven: Immune repertoire sequencing assay for measurement of the isotype and clonal composition of the circulating B cell repertoire to detect acute allograft rejection in heart transplant recipients.; Experimental, investigational, or unproven: myTAIHEART test (TAI Diagnostics, Inc., Milwaukee, WI) for evaluating graft rejection following heart transplant and all other indications.; Experimental, investigational, or unproven: Measurement of cardiac troponins for diagnosis of acute cellular rejection following heart transplantation, and for assessing prognosis of primary graft failure in heart transplant recipients.; Experimental, investigational, or unproven: Measurement of donor-derived cell-free DNA (Allosure, Prospera Test) of transplant recipients for monitoring of rejection.; Experimental, investigational, or unproven: Measurement of pulmonary artery size as a predictor of early post-operative heart transplantation outcomes.; Experimental, investigational, or unproven: Heart Molecular Microscope Diagnostic System (MMDx-Heart) for evaluation of cardiac transplant rejection.; Experimental, investigational, or unproven: TransMedics Organ Care System for preservation and transport of donor heart.; Experimental, investigational, or unproven: The use of machine learning and artificial intelligence in cardiac transplantation.; Experimental, investigational, or unproven: The Prospera Heart test for detection of acute rejection, including antibody-mediated rejection (AMR) and acute cellular rejection (ACR) in heart transplantation. Claims may be denied when the requested service falls under these. Some of these are conditional (note the stated exceptions) — confirm specifics against the bulletin.
Does Aetna require prior authorization for Heart Transplantation?
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
What does Aetna exclude for Heart Transplantation?
Policy exclusions and limitations: Contraindication (heart transplant NOT medically necessary if ANY present): Presence of irreversible end-organ diseases (e.g., renal, hepatic, pulmonary) — UNLESS person is to undergo dual organ transplantation (e.g., heart-lung, heart-kidney, etc.).; Contraindication (NOT medically necessary if present): Presence of severe pulmonary hypertension with irreversibly high pulmonary vascular resistance.; Contraindication (NOT medically necessary if present): Presence of a recent intra-cranial cerebrovascular event with significant persistent deficit.; Contraindication (NOT medically necessary if present): Presence of bleeding peptic ulcer.; Contraindication (NOT medically necessary if present): Presence of hepatitis B antigen.; Contraindication (NOT medically necessary if present): Presence of diverticulitis.; Contraindication (NOT medically necessary if present): Presence of immediately life-threatening neuromuscular disorders.; Contraindication (NOT medically necessary if present): Presence of HIV/AIDS with profound immunosuppression (CD4 count of less than 200 cells/mm3).; Contraindication (NOT medically necessary if present): Presence of AL amyloidosis — EXCEPTION may be made where curative therapy of amyloidosis has been performed or is planned (e.g., stem cell transplantation in primary amyloidosis, liver transplantation in familial amyloidosis).; Experimental, investigational, or unproven: Total artificial heart (e.g., ABIOCOR Total Artificial Heart, SynCardia temporary Total Artificial Heart, formerly CardioWest Total Artificial Heart) as PERMANENT treatment (destination therapy) / alternative to heart transplantation — safety and effectiveness not established.; Experimental, investigational, or unproven: AlloMap gene expression profile for ALL OTHER indications (other than monitoring rejection more than 2 months post-transplant) — clinical value not established.; Experimental, investigational, or unproven: Xenotransplantation of the heart — cardiac xenotransplantation (e.g., porcine xenografts).; Experimental, investigational, or unproven: Heartsbreath Test (Menassana Research, Inc) for diagnosing heart transplant rejection and for all other indications.; Experimental, investigational, or unproven: Cytokine gene polymorphism testing for evaluating graft rejection following heart transplantation.; Experimental, investigational, or unproven: Immune repertoire sequencing assay for measurement of the isotype and clonal composition of the circulating B cell repertoire to detect acute allograft rejection in heart transplant recipients.; Experimental, investigational, or unproven: myTAIHEART test (TAI Diagnostics, Inc., Milwaukee, WI) for evaluating graft rejection following heart transplant and all other indications.; Experimental, investigational, or unproven: Measurement of cardiac troponins for diagnosis of acute cellular rejection following heart transplantation, and for assessing prognosis of primary graft failure in heart transplant recipients.; Experimental, investigational, or unproven: Measurement of donor-derived cell-free DNA (Allosure, Prospera Test) of transplant recipients for monitoring of rejection.; Experimental, investigational, or unproven: Measurement of pulmonary artery size as a predictor of early post-operative heart transplantation outcomes.; Experimental, investigational, or unproven: Heart Molecular Microscope Diagnostic System (MMDx-Heart) for evaluation of cardiac transplant rejection.; Experimental, investigational, or unproven: TransMedics Organ Care System for preservation and transport of donor heart.; Experimental, investigational, or unproven: The use of machine learning and artificial intelligence in cardiac transplantation.; Experimental, investigational, or unproven: The Prospera Heart test for detection of acute rejection, including antibody-mediated rejection (AMR) and acute cellular rejection (ACR) in heart transplantation. Claims may be denied when the requested service falls under these. Some of these are conditional (note the stated exceptions) — confirm specifics against the bulletin.

Source

Aetna CPB 0586 — Heart Transplantation

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Coverage disclaimer

This page summarizes Aetna clinical-coverage criteria extracted from policy CPB 0586 for educational purposes. Coverage policies change and vary by individual plan. Always verify against Aetna's current policy before performing a procedure or submitting a claim. d3rx is not responsible for claim denials or reimbursement issues.