TL;DR: Aetna, a CVS Health company, modified CPB 0605 governing intestinal transplantation coverage, effective September 26, 2025. Here's what billing teams need to know before that date.
This update to the Aetna intestinal transplantation coverage policy touches CPT codes 44132 through 44137 for donor and recipient procedures, HCPCS codes S2053, S2054, and S2055 for multivisceral and small intestine transplants, and a broad set of supporting codes covering central venous access (36555–36597) and total parenteral nutrition. CPB 0605 in the Aetna system governs one of the most complex and high-dollar procedure sets your billing team will encounter. If you bill transplant services for Aetna members, review your charge capture and prior authorization workflows before September 26, 2025.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Intestinal Transplantation — CPB 0605 |
| Policy Code | CPB 0605 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | High |
| Specialties Affected | Transplant surgery, gastroenterology, general surgery, nutrition support, interventional radiology |
| Key Action | Audit prior authorization workflows and charge capture for CPT 44132–44137 and HCPCS S2053–S2055 before September 26, 2025 |
Aetna Intestinal Transplantation Coverage Criteria and Medical Necessity Requirements 2025
Intestinal transplantation billing is high-stakes. These procedures run into six figures, prior authorization is non-negotiable, and a single documentation gap can trigger a claim denial that takes months to resolve.
Aetna's coverage policy under CPB 0605 covers intestinal transplantation when medical necessity criteria are met. The core covered procedures are intestinal allotransplantation from a cadaver donor (CPT 44135) and from a living donor (CPT 44136). Donor enterectomy procedures — CPT 44132 for open cadaver donor and CPT 44133 for partial living donor — are also covered when selection criteria are satisfied.
Backbench preparation and reconstruction codes are covered under the same conditions. That means CPT 44715 for standard backbench preparation of the intestine allograft, CPT 44720 for venous reconstruction, and CPT 44721 for arterial anastomosis are all on the covered list. These codes often get missed in charge capture because they sit between the donor and recipient procedures. Make sure your transplant surgeons are documenting and your coders are capturing every one of them.
For multivisceral and combined liver-intestine transplants, the covered HCPCS codes are S2053 (small intestine and liver allograft transplantation), S2054 (multivisceral organ transplantation), and S2055 (harvesting of donor multivisceral organs). These are high-dollar codes. Confirm your payer contracts and fee schedule rates for these HCPCS codes before you submit.
Prior authorization is standard for transplant procedures at this complexity level. Do not assume a referral or a surgical scheduling approval substitutes for a formal prior auth. Intestinal transplantation billing without a documented prior authorization almost always ends in denial. Loop in your authorization team the moment a patient is listed as a transplant candidate.
Medical necessity documentation needs to go beyond the surgical indication. Aetna will look at the full clinical picture — the underlying condition, failure of alternative therapies like total parenteral nutrition, and the patient's functional status. Your clinical team needs to build that case in the record before the auth request goes out.
Aetna Intestinal Transplantation Exclusions and Non-Covered Indications
CPT 83993 — fecal calprotectin — is explicitly listed as not covered for the indications in CPB 0605. This is a meaningful carve-out.
Fecal calprotectin is sometimes ordered in the workup or post-transplant monitoring of intestinal transplant patients. Under this coverage policy, billing 83993 in connection with this patient population will not get reimbursement from Aetna. If your institution uses calprotectin as part of transplant surveillance protocols, document clearly that the order is outside the transplant indication — or expect a denial.
This is the kind of exclusion that doesn't show up on payer-submitted code lists and catches billing teams off guard. Pull this code out of any transplant order sets that include it by default.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Intestinal allotransplantation — cadaver donor | Covered | CPT 44135 | Selection criteria must be met; prior auth required |
| Intestinal allotransplantation — living donor | Covered | CPT 44136 | Selection criteria must be met; prior auth required |
| Donor enterectomy — cadaver (open) | Covered | CPT 44132 | Covered when transplant criteria met |
| Donor enterectomy — partial, living donor | Covered | CPT 44133 | Covered when transplant criteria met |
| Removal of transplanted intestinal allograft (complete) | Covered | CPT 44137 | Selection criteria must be met |
| Backbench preparation — cadaver or living donor intestine | Covered | CPT 44715 | Commonly missed in charge capture |
| Backbench reconstruction — venous | Covered | CPT 44720 | Covered with transplant procedure |
| Backbench reconstruction — arterial anastomosis | Covered | CPT 44721 | Per anastomosis; document each |
| Small intestine and liver allograft transplantation | Covered | HCPCS S2053 | Selection criteria must be met |
| Multivisceral organ transplantation | Covered | HCPCS S2054 | Selection criteria must be met |
| Donor multivisceral organ harvesting | Covered | HCPCS S2055 | Cadaver donor; selection criteria must be met |
| Fecal calprotectin (post-transplant surveillance) | Not Covered | CPT 83993 | Explicitly excluded for indications in CPB 0605 |
| Central venous access procedures | Related (not primary transplant codes) | CPT 36555–36597 | Support TPN and post-transplant care; check separate coverage |
| Total parenteral nutrition — home infusion | Related (not primary transplant codes) | HCPCS S9364–S9368, B4164–B5200 | TPN dependency is often the underlying transplant indication |
| Liver allotransplantation | Related (not primary transplant codes) | CPT 47135, 47143–47147 | Relevant for combined liver-intestine transplants |
Aetna Intestinal Transplantation Billing Guidelines and Action Items 2025
| # | Action Item |
|---|---|
| 1 | Audit your prior authorization workflow before September 26, 2025. Every transplant procedure under CPB 0605 requires a formal prior auth. Review your current process for Aetna members. Confirm your team knows the specific criteria Aetna will use to evaluate medical necessity. A missing or insufficient auth is the fastest path to a claim denial on a six-figure claim. |
| 2 | Update your charge capture to include backbench codes. CPT 44715, 44720, and 44721 are frequently missed because they occur in the prep phase before the recipient surgery. These codes are covered when selection criteria are met. Make sure your transplant surgeons know to document them, and make sure your coders know to capture them. The revenue loss from missing these on a single case is significant. |
| 3 | Remove CPT 83993 from transplant order sets. Fecal calprotectin is not covered for indications in CPB 0605. If your institution uses it as a default post-transplant surveillance tool for Aetna patients, pull it from standing order sets now. Bill it only when the clinical indication is clearly outside the transplant context — and document that distinction in the record. |
| 4 | Verify fee schedule reimbursement for HCPCS S2053, S2054, and S2055. These multivisceral and combined transplant codes are not standard on every fee schedule. Confirm your Aetna contract rates for these codes before September 26, 2025. If they're not contracted, you need to know that before you submit — not after you get a denial. |
| 5 | Audit your TPN and central venous access billing separately. The CPB 0605 policy lists central venous access codes (CPT 36555–36597) and TPN codes (HCPCS S9364–S9368, B4164–B5200, B9004, B9006) as related codes. These often run concurrent with transplant episodes and are subject to their own coverage rules. Make sure your billing team isn't bundling them incorrectly into the transplant claim. |
| 6 | Document TPN failure before submitting transplant prior auth requests. Total parenteral nutrition dependency is a core indication for intestinal transplantation. Aetna will expect documentation that TPN has been tried and has either failed or is causing significant complications. Build this evidence into the prior auth package from the start. Your gastroenterology and nutrition support teams need to be part of this documentation process. |
| 7 | If you're billing combined liver-intestine transplants, check CPT 47135 and related liver codes. CPT 47135, 47143, 47144, 47145, 47146, and 47147 are listed as related codes in this policy. Combined procedures have additional complexity in documentation and coding. If you're not sure how to structure the claim for a multivisceral case, talk to your compliance officer or transplant billing consultant before the September 26, 2025 effective date. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Intestinal Transplantation Under CPB 0605
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Description |
|---|---|
| 44132 | Donor enterectomy (including cold preservation), open; from cadaver donor |
| 44133 | Donor enterectomy, partial, from living donor |
| 44135 | Intestinal allotransplantation; from cadaver donor |
| 44136 | Intestinal allotransplantation; from living donor |
| 44137 | Removal of transplanted intestinal allograft, complete |
| 44715 | Backbench standard preparation of cadaver or living donor intestine allograft prior to transplantation |
| 44720 | Backbench reconstruction of cadaver or living donor intestine allograft prior to transplantation; venous anastomosis |
| 44721 | Backbench reconstruction; arterial anastomosis, each |
Covered HCPCS Codes (When Selection Criteria Are Met)
| Code | Description |
|---|---|
| S2053 | Transplantation of small intestine and liver allografts |
| S2054 | Transplantation of multivisceral organs |
| S2055 | Harvesting of donor multivisceral organs, with preparation and maintenance of allografts; from cadaver donor |
Not Covered CPT Codes
| Code | Description | Reason |
|---|---|---|
| 83993 | Calprotectin, fecal | Not covered for indications listed in CPB 0605 |
Key ICD-10-CM Diagnosis Codes
The full policy includes 165 ICD-10-CM codes. The data provided includes streptococcal sepsis codes (A40.0–A40.8) as part of the covered diagnosis set. These likely support complications and post-transplant infection diagnoses. Pull the complete ICD-10 list from the full CPB 0605 policy document to make sure your billing team is coding to the right level of specificity. Using an unspecified or mismatched diagnosis code on a transplant claim is a fast way to trigger a medical necessity denial.
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