Cigna modified MM 0129 covering heart, lung, and heart-lung transplantation, effective September 26, 2025. Here's what billing teams need to do.
Cigna Healthcare updated its coverage policy for thoracic organ transplantation under policy code MM 0129 (Cigna internal reference: mm_0129_coveragepositioncriteria_heart_transplantation). This modification affects 13 CPT codes and three HCPCS codes spanning donor procurement, organ preparation, and transplant procedures — including CPT 33945 for heart transplant, CPT 32851–32854 for single and double lung transplants, and HCPCS S2060–S2061 for lobar lung transplantation. If your facility or billing team handles thoracic transplant services, this coverage policy change is active now.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Cigna Healthcare |
| Policy | Heart, Lung, and Heart-Lung Transplantation |
| Policy Code | MM 0129 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | High |
| Specialties Affected | Cardiothoracic surgery, transplant programs, transplant coordination, hospital billing |
| Key Action | Audit charge capture for all 16 affected CPT and HCPCS codes against updated medical necessity criteria before billing any post-September 26 claims |
Cigna Heart, Lung, and Heart-Lung Transplantation Coverage Criteria and Medical Necessity Requirements 2025
The MM 0129 Cigna coverage policy covers transplantation of the thoracic organs — heart, lung, lung lobes, or a combined heart-lung from a cadaver or living donor. The policy addresses the full surgical episode: donor procurement, organ preparation (backbench work), and the transplant procedure itself.
Every covered code in this policy carries the same threshold requirement: the procedure is considered medically necessary when the applicable selection criteria are met. Cigna does not publish those criteria in vague terms. Your team needs the full policy document to verify exactly which patient-level criteria apply to each procedure type.
Donor organ procurement and transport are addressed separately under Cigna Omnibus Reimbursement Policy R24. If your team bills procurement codes alongside transplant codes, cross-reference both policies. Billing these together without confirming alignment between MM 0129 and R24 is a fast path to claim denial.
Prior authorization is standard for transplant procedures with major payers, and Cigna is no exception. Before any elective transplant admission, confirm prior auth requirements with Cigna directly. The effective date of September 26, 2025 means claims for services on or after that date fall under the updated policy terms — not the prior version.
Medical necessity documentation is non-negotiable here. Thoracic transplants are high-dollar, high-scrutiny claims. Cigna will review clinical documentation against its selection criteria. If your clinical teams aren't documenting to those criteria explicitly, your reimbursement is at risk.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Heart transplant (cadaver donor) | Covered when criteria met | CPT 33945, 33940, 33944 | Medical necessity criteria apply; prior auth required |
| Lung transplant, single, without cardiopulmonary bypass | Covered when criteria met | CPT 32851 | Medical necessity criteria apply |
| Lung transplant, single, with cardiopulmonary bypass | Covered when criteria met | CPT 32852 | Medical necessity criteria apply |
| Lung transplant, double (bilateral sequential or en bloc), without cardiopulmonary bypass | Covered when criteria met | CPT 32853 | Medical necessity criteria apply |
| Lung transplant, double (bilateral sequential or en bloc), with cardiopulmonary bypass | Covered when criteria met | CPT 32854 | Medical necessity criteria apply |
| Lobar lung transplantation | Covered when criteria met | HCPCS S2060 | Medical necessity criteria apply |
| Living donor lobectomy for transplantation | Covered when criteria met | HCPCS S2061 | Living donor; medical necessity criteria apply |
| Heart-lung transplant with recipient cardiectomy-pneumonectomy | Covered when criteria met | CPT 33935, 33930, 33933 | Combined procedure; medical necessity criteria apply |
| Donor pneumonectomy from cadaver donor | Covered when criteria met | CPT 32850 | Cadaver donor procurement |
| Backbench preparation, cadaver donor lung (single) | Covered when criteria met | CPT 32855 | Preparation prior to transplantation |
| Backbench preparation, cadaver donor lung (double/bilateral) | Covered when criteria met | CPT 32856 | Preparation prior to transplantation |
| Backbench preparation, cadaver donor heart allograft | Covered when criteria met | CPT 33944 | Preparation prior to transplantation |
| Backbench preparation, cadaver donor heart/lung allograft | Covered when criteria met | CPT 33933 | Combined heart/lung preparation |
| Solid organ transplant (deceased or living donor) | Covered when criteria met | HCPCS S2152 | Broad solid organ code; verify specificity with Cigna |
Cigna Heart and Lung Transplantation Billing Guidelines and Action Items 2025
These are direct action items for your billing and revenue cycle teams based on the MM 0129 update.
| # | Action Item |
|---|---|
| 1 | Pull your charge capture for all 16 codes and verify they map to the updated policy. That includes CPT 32850–32856, 33930, 33933, 33935, 33940, 33944, 33945, and HCPCS S2060, S2061, S2152. Any code billed for services on or after September 26, 2025 falls under the new policy terms. |
| 2 | Cross-reference Cigna Omnibus Reimbursement Policy R24 before billing donor procurement and transport. MM 0129 explicitly routes organ procurement and transport to R24. If your team bills CPT 32850, 33930, or 33940 for cadaver donor procurement, make sure R24 is part of your billing workflow — not just MM 0129. |
| 3 | Confirm prior authorization requirements with Cigna for every scheduled transplant case. Transplant procedures are high-cost, high-scrutiny services. Cigna prior authorization requirements can vary by plan type. Don't assume a prior auth that was valid under the old policy version carries forward unchanged. |
| 4 | Audit your medical necessity documentation templates against Cigna's current selection criteria. The policy states these procedures are covered "when criteria in the applicable selection criteria are met." Your clinical documentation needs to reflect those criteria explicitly — not just the diagnosis and procedure. Update any templates your transplant coordinators or physicians use for Cigna cases. |
| 5 | Flag HCPCS S2152 for special review. This code — solid organ transplant, deceased or living donor — is broad. Cigna may expect a more procedure-specific code alongside it or instead of it. Verify with your Cigna provider rep how S2152 is expected to be used in the context of heart or lung transplants, and whether it should be billed in addition to or instead of the procedure-specific CPT codes. |
| 6 | Check living donor billing separately. HCPCS S2061 (donor lobectomy, living donor) triggers different clinical and administrative requirements than cadaver donor codes. Living donor procedures involve a healthy patient undergoing surgery — documentation standards and prior authorization paths are different. Make sure your team isn't running living donor claims through the same workflow as cadaver donor claims. |
| 7 | If your facility is a transplant center billing these services under a global or bundled arrangement, loop in your compliance officer before the September 26 effective date. High-dollar transplant billing under modified policy terms, especially where bundling is involved, carries real exposure. Get your compliance officer and billing consultant aligned on how the update applies to your specific contract and charge structure. |
| 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 Heart, Lung, and Heart-Lung Transplantation Under MM 0129
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 32850 | CPT | Donor pneumonectomy(s) (including cold preservation), from cadaver donor |
| 32851 | CPT | Lung transplant, single; without cardiopulmonary bypass |
| 32852 | CPT | Lung transplant, single; with cardiopulmonary bypass |
| 32853 | CPT | Lung transplant, double (bilateral sequential or en bloc); without cardiopulmonary bypass |
| 32854 | CPT | Lung transplant, double (bilateral sequential or en bloc); with cardiopulmonary bypass |
| 32855 | CPT | Backbench standard preparation of cadaver donor lung allograft prior to transplantation (single) |
| 32856 | CPT | Backbench standard preparation of cadaver donor lung allograft prior to transplantation (double/bilateral) |
| 33930 | CPT | Donor cardiectomy-pneumonectomy (including cold preservation) |
| 33933 | CPT | Backbench standard preparation of cadaver donor heart/lung allograft prior to transplantation |
| 33935 | CPT | Heart-lung transplant with recipient cardiectomy-pneumonectomy |
| 33940 | CPT | Donor cardiectomy (including cold preservation) |
| 33944 | CPT | Backbench standard preparation of cadaver donor heart allograft prior to transplantation |
| 33945 | CPT | Heart transplant, with or without recipient cardiectomy |
Covered HCPCS Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| S2060 | HCPCS | Lobar lung transplantation |
| S2061 | HCPCS | Donor lobectomy (lung) for transplantation, living donor |
| S2152 | HCPCS | Solid organ(s), complete or segmental, single organ or combination of organs; deceased or living donor |
Note on ICD-10-CM codes: The MM 0129 policy data does not list specific ICD-10-CM diagnosis codes. Your transplant billing team should use the appropriate ICD-10 codes for the underlying condition (e.g., end-stage heart failure, end-stage pulmonary disease) that supports medical necessity. Confirm those with your clinical documentation team and Cigna's current coverage criteria.
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