Cigna modified MM 0288 for intestinal and multivisceral transplantation, effective February 24, 2026. Here's what billing teams need to know before submitting claims.
Cigna Healthcare updated its intestinal and multivisceral transplant coverage policy under MM 0288 in February 2026. This modification covers 17 CPT codes — including 44132, 44135, 44136, 44137, 44133, and a full suite of hepatic and pancreatic backbench codes — and draws a hard line between covered and non-covered donor types. If your team handles intestinal transplant billing for Cigna members, this coverage policy directly affects your claim outcomes.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Cigna Healthcare |
| Policy | Intestinal and Multivisceral Transplantation |
| Policy Code | MM 0288 |
| Change Type | Modified |
| Effective Date | February 24, 2026 |
| Impact Level | High |
| Specialties Affected | Transplant surgery, hepatobiliary surgery, pancreatic surgery, transplant program billing and RCM |
| Key Action | Audit charge capture for CPT 44133 and 44136 — living donor intestinal procedures are explicitly not covered under this policy |
Cigna Intestinal and Multivisceral Transplant Coverage Criteria and Medical Necessity Requirements 2026
The Cigna intestinal transplantation coverage policy under MM 0288 covers primary and repeat intestinal organ transplantation from deceased donors and deceased donor multivisceral organ transplantation. Cigna also addresses living donor intestinal transplantation — but not favorably.
For the 15 CPT codes on the covered list, Cigna requires that cases meet the applicable selection criteria outlined in MM 0288. Cigna treats cadaver-donor intestinal transplants (CPT 44135) and donor enterectomy from a cadaver (CPT 44132) as medically necessary when those criteria are satisfied. The same logic applies to the multivisceral component codes — CPT 47133, 47135, 47143–47147 for liver, and CPT 48550–48556 for pancreas.
Medical necessity documentation matters here. Cigna's policy is explicit that coverage depends on meeting the applicable criteria — which means your prior authorization request needs to reflect the right clinical indicators before the procedure, not after. If your transplant program bills Cigna and hasn't confirmed what those selection criteria are for the specific transplant type, confirm that with your transplant coordinator and compliance officer before the February 24, 2026 effective date passes without a review.
The policy also addresses contraindications. Cases with contraindications to transplantation are not covered. Cigna doesn't just gate coverage on positive criteria — it excludes on negative ones too. That distinction matters for claim denial prevention.
Prior authorization is standard for transplant procedures at this complexity level. Assume your team needs prior auth for any intestinal or multivisceral transplant claim under this policy. Don't submit without it.
Cigna Intestinal Transplant Exclusions and Non-Covered Indications
Two codes in MM 0288 carry a flat "not medically necessary" designation — and they're both living donor procedures.
CPT 44133 (donor enterectomy, open, partial, from living donor) is not covered. CPT 44136 (intestinal allotransplantation from living donor) is not covered. Full stop.
This is the real issue with this policy update. Living donor intestinal transplantation sits at the intersection of surgical complexity and payer skepticism. Cigna's position is that the living donor pathway doesn't meet medical necessity standards under MM 0288. That means if your transplant program performs living donor intestinal transplants and bills Cigna, you're looking at a claim denial regardless of documentation quality.
The covered codes are exclusively cadaver-donor and multivisceral — deceased donor-sourced. Living donor liver and kidney transplants have a different, longer history of payer acceptance. Living donor intestinal transplant is a much smaller volume procedure, and Cigna's non-coverage position here isn't surprising. But if your program has built any volume around living donor intestinal cases, this needs an immediate conversation with your transplant program director and billing consultant.
Don't bill 44133 or 44136 to Cigna and hope for the best. You won't get reimbursement, and repeated denials create audit exposure.
Coverage Indications at a Glance
| Indication | Status | Relevant CPT Codes | Notes |
|---|---|---|---|
| Cadaver donor intestinal transplantation | Covered (when criteria met) | 44132, 44135 | Medical necessity criteria must be met; prior auth expected |
| Multivisceral transplantation (deceased donor) | Covered (when criteria met) | 44132, 44135, 47133, 47135, 48550, 48554 | Includes liver and pancreas component codes |
| Removal of transplanted intestinal allograft | Covered (when criteria met) | 44137 | Applies to complete removal of allograft |
| Liver allotransplantation (cadaver or living donor) | Covered (when criteria met) | 47133, 47135 | Living donor liver transplant included in covered codes |
| Backbench preparation — liver (cadaver) | Covered (when criteria met) | 47143, 47144, 47145 | Standard preparation codes; must accompany transplant procedure |
| Backbench reconstruction — liver | Covered (when criteria met) | 47146, 47147 | Venous and arterial reconstruction codes |
| Donor pancreatectomy (cadaver) | Covered (when criteria met) | 48550 | Cold preservation included |
| Backbench preparation and reconstruction — pancreas | Covered (when criteria met) | 48551, 48552 | Standard prep and venous anastomosis reconstruction |
| Pancreatic allograft transplantation | Covered (when criteria met) | 48554 | Cadaver donor |
| Removal of transplanted pancreatic allograft | Covered (when criteria met) | 48556 | — |
| Living donor intestinal transplantation | Not Covered | 44133, 44136 | Cigna considers not medically necessary — expect claim denial |
| Cases with contraindications to transplantation | Not Covered | All applicable codes | Contraindications explicitly excluded |
Cigna Intestinal Transplant Billing Guidelines and Action Items 2026
The effective date is February 24, 2026. These steps need to happen now, not when you're staring at a denied claim.
| # | Action Item |
|---|---|
| 1 | Flag CPT 44133 and 44136 in your charge capture system. Add a hard stop or alert for any claim targeting Cigna members that includes these living donor intestinal codes. Your billers need to know before the claim goes out — not after the denial comes back. |
| 2 | Confirm prior authorization workflows for all covered transplant codes. For CPT 44135, 47135, and 48554 specifically, verify that your transplant program's PA requests to Cigna include documentation of the applicable medical necessity criteria from MM 0288. A PA approval without the right criteria documented doesn't protect you if Cigna audits retrospectively. |
| 3 | Update your internal billing guidelines to separate deceased donor and living donor intestinal procedures. This sounds basic, but transplant programs that handle both need clear internal documentation showing which codes are Cigna-billable. Mixing these up in a busy transplant billing environment is how 44133 slips through. |
| 4 | Review any pending or recently submitted claims that include 44133 or 44136. If you've submitted these to Cigna after February 24, 2026, pull those claims. You may need to work a corrected claim or appeal — but more importantly, you need to assess the reimbursement exposure. |
| 5 | Verify that backbench codes are paired correctly with transplant codes. CPT 47143–47147 for liver and 48551–48552 for pancreas need to accompany the relevant transplant codes (47135, 48554) and be supported by operative documentation. Backbench codes that appear without the primary transplant procedure code are a payer audit flag. |
| 6 | Audit contraindication documentation. Cigna excludes cases with contraindications to transplantation. If a case proceeded despite documented contraindications, your claim is at risk regardless of the procedure performed. Work with your transplant coordinators to confirm pre-transplant evaluation documentation is consistent with Cigna's coverage position. |
| 7 | Talk to your compliance officer if your program has any Cigna-contracted living donor intestinal cases in the pipeline. This isn't a gray area — Cigna calls 44133 and 44136 not medically necessary. If you have pending cases, you need a compliance and financial counseling conversation with the patient before the procedure, not after. |
| 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 and Multivisceral Transplantation Under MM 0288
Covered CPT Codes (When Medical Necessity Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 44132 | CPT | Donor enterectomy (including cold preservation), open; from cadaver donor |
| 44135 | CPT | Intestinal allotransplantation; from cadaver donor |
| 44137 | CPT | Removal of transplanted intestinal allograft, complete |
| 47133 | CPT | Donor hepatectomy (including cold preservation), from cadaver donor |
| 47135 | CPT | Liver allotransplantation; orthotopic, partial or whole, from cadaver or living donor, any age |
| 47143 | CPT | Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation (standard preparation) |
| 47144 | CPT | Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation (trisegment split) |
| 47145 | CPT | Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation (lobe split) |
| 47146 | CPT | Backbench reconstruction of cadaver or living donor liver graft prior to allotransplantation; venous anastomosis |
| 47147 | CPT | Backbench reconstruction of cadaver or living donor liver graft prior to allotransplantation; arterial anastomosis |
| 48550 | CPT | Donor pancreatectomy (including cold preservation), with or without duodenal segment for transplantation |
| 48551 | CPT | Backbench standard preparation of cadaver donor pancreas allograft prior to transplantation |
| 48552 | CPT | Backbench reconstruction of cadaver donor pancreas allograft prior to transplantation, venous anastomosis |
| 48554 | CPT | Transplantation of pancreatic allograft |
| 48556 | CPT | Removal of transplanted pancreatic allograft |
Not Covered CPT Codes
| Code | Type | Description | Reason |
|---|---|---|---|
| 44133 | CPT | Donor enterectomy (including cold preservation), open; partial, from living donor | Cigna considers not medically necessary |
| 44136 | CPT | Intestinal allotransplantation; from living donor | Cigna considers not medically necessary |
No HCPCS Level II or ICD-10-CM codes are listed in MM 0288. The policy does not publish specific diagnosis codes. Your team should use the ICD-10-CM codes that reflect the patient's underlying condition driving transplant necessity — and confirm those codes align with the medical necessity criteria Cigna requires for the applicable procedure.
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