Appendix E - National Coverage Determinations Manual / Intestinal and Multi-Visceral Transplantation

Why This Topic Matters

Coverage for these transplants is highly specialized and tied to specific program criteria and facility standards. Understanding the policy helps organizations assess whether a case fits within Medicare’s nationally covered indications and whether a transplant center meets approval requirements.

Article Sections

1. A. General

   Introduces the Medicare coverage policy for intestinal and multi-visceral transplantation and defines the general clinical context addressed by the determination. It also references age-related considerations and the role of national transplant data.

2. B. Nationally Covered Indications

   Outlines the circumstances under which the procedure is covered and organizes the policy around failure of total parenteral nutrition and approved transplant facilities. The section describes the broad categories of clinical circumstances and administrative requirements considered by the determination.

3. 1. Failed TPN

   Describes the general types of situations that the policy treats as evidence of total parenteral nutrition failure. The discussion focuses on clinical complications and loss of treatment effectiveness at a broad level.

4. 2. Approved Transplant Facilities

   Summarizes the facility-level standards for Medicare coverage, including volume and survival-based approval criteria. This section addresses how transplant centers are evaluated for coverage purposes.

5. C. Nationally Non-covered Indications

   States the category of indications that are not covered under the policy. It provides the general non-coverage framework without listing additional exceptions.

6. D. Other

   Contains miscellaneous administrative content and closing notation for the policy update.