Cigna modified MM 0288 for intestinal and multivisceral transplantation, effective February 24, 2026. Here's what changes for billing teams.
Cigna Healthcare updated its coverage policy for intestinal and multivisceral transplantation under policy code MM 0288. The update covers primary and repeat intestinal organ transplantation from both deceased and living donors, plus deceased donor multivisceral organ transplantation. Seventeen CPT codes are affected — including 44132, 44135, 44137, 47133, 47135, 48550, 48554, and others — and two of those codes (44133 and 44136, both covering living donor intestinal transplants) are now explicitly designated as not medically necessary.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Cigna Healthcare |
| Policy | Intestinal and Multivisceral Transplantation |
| Policy Code | MM 0288 |
| Change Type | Modified |
| Effective Date | 2026-02-24 |
| Impact Level | High |
| Specialties Affected | Transplant surgery, hepatobiliary surgery, general surgery, transplant program billing |
| Key Action | Audit your charge capture for CPT 44133 and 44136 — Cigna now considers these not medically necessary |
Cigna Intestinal Transplantation Coverage Criteria and Medical Necessity Requirements 2026
The Cigna intestinal and multivisceral transplant coverage policy under MM 0288 draws a clear line: deceased donor procedures can meet medical necessity, living donor intestinal transplants do not.
For deceased donor cases, Cigna covers the full transplant workflow. That includes donor organ procurement (CPT 44132 for cadaver enterectomy, 47133 for donor hepatectomy, 48550 for donor pancreatectomy), backbench preparation codes (47143, 47144, 47145, 47146, 47147 for liver; 48551, 48552 for pancreas), and the transplantation itself (CPT 44135 for intestinal allotransplantation from a cadaver donor, 47135 for liver allotransplantation, 48554 for pancreatic allograft transplantation). Allograft removal codes — 44137 for intestinal and 48556 for pancreatic — are also covered when criteria are met.
The coverage policy requires that these procedures meet applicable selection criteria. The policy doesn't publish those criteria line by line in the billing-facing summary, but your prior authorization team needs to have clinical documentation ready before claims go out. If you're billing for transplant programs and haven't confirmed what Cigna's current selection criteria look like internally, talk to your compliance officer before submitting claims after the February 24, 2026 effective date.
Reimbursement for these procedures is tied to medical necessity determination at the claim level. Cigna will deny claims that don't meet selection criteria, even for the covered codes.
Cigna Intestinal Transplantation Exclusions and Non-Covered Indications
This is the part that will actually move the needle for transplant billing teams in 2026.
CPT 44133 (donor enterectomy from a living donor) and CPT 44136 (intestinal allotransplantation from a living donor) are both designated as not medically necessary under MM 0288. Full stop. Cigna isn't categorizing these as experimental or investigational — they're simply not covered.
That's a meaningful distinction. Experimental designations sometimes create an appeals pathway through clinical exception processes. A flat "not medically necessary" designation closes that door faster. If your transplant program performs living donor intestinal procedures and you have Cigna-covered patients, you need a financial counseling and consent process in place before surgery — not after the claim denial comes back.
This is also worth flagging to your medical director. Living donor intestinal transplant is a rare but real procedure at select high-volume centers. If Cigna is a significant payer in your market and your program does this work, you're looking at self-pay exposure on those cases unless you have an individual coverage exception in writing before the procedure.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Cadaver donor intestinal procurement | Covered (criteria must be met) | 44132 | Prior auth recommended; clinical criteria apply |
| Intestinal allotransplantation from cadaver donor | Covered (criteria must be met) | 44135 | Full transplant procedure; document medical necessity |
| Removal of transplanted intestinal allograft | Covered (criteria must be met) | 44137 | Applies to complete removal |
| Cadaver donor hepatectomy for transplant | Covered (criteria must be met) | 47133 | Part of multivisceral procurement |
| Liver allotransplantation (cadaver or living donor) | Covered (criteria must be met) | 47135 | Any age; orthotopic, partial or whole |
| Backbench preparation — cadaver liver graft (standard) | Covered (criteria must be met) | 47143, 47144, 47145 | Multiple codes by configuration |
| Backbench reconstruction — cadaver/living liver graft | Covered (criteria must be met) | 47146, 47147 | Venous and arterial reconstruction |
| Cadaver donor pancreatectomy | Covered (criteria must be met) | 48550 | Includes cold preservation; with or without duodenal segment |
| Backbench preparation — cadaver pancreas allograft | Covered (criteria must be met) | 48551 | Standard preparation |
| Backbench reconstruction — cadaver pancreas allograft | Covered (criteria must be met) | 48552 | Venous anastomosis |
| Pancreatic allograft transplantation | Covered (criteria must be met) | 48554 | Full transplant |
| Removal of transplanted pancreatic allograft | Covered (criteria must be met) | 48556 | Allograft removal |
| Living donor intestinal procurement | Not Medically Necessary | 44133 | Cigna will not cover; financial counseling required before procedure |
| Intestinal allotransplantation from living donor | Not Medically Necessary | 44136 | Cigna will not cover; expect claim denial if submitted |
Cigna Intestinal Transplantation Billing Guidelines and Action Items 2026
| # | Action Item |
|---|---|
| 1 | Pull all open cases involving CPT 44133 and 44136 before February 24, 2026. If you have any pending Cigna claims or scheduled cases involving living donor intestinal procedures, flag them now. The effective date has passed — if you're reading this after February 24, audit your recent claim submissions immediately. |
| 2 | Update your charge capture system to flag CPT 44133 and 44136 for Cigna patients. These codes should trigger an automatic review before billing. Set the flag to require compliance sign-off before submission. A claim denial on a transplant-level procedure creates significant write-off exposure. |
| 3 | Confirm prior authorization requirements with Cigna directly for all covered codes. The policy ties coverage to selection criteria. Prior auth is the mechanism Cigna uses to validate those criteria before reimbursement. Don't bill CPT 44135, 47135, or 48554 without a confirmed authorization on file. |
| 4 | Update your financial counseling workflow for living donor intestinal transplant cases. If your program performs living donor intestinal procedures and Cigna is one of the patient's insurers, your financial counselors need to have a "not covered" conversation before surgery. Document it. Get the patient's acknowledgment in writing. This protects both the patient and your program. |
| 5 | Review multivisceral transplant cases for complete code capture. MM 0288 covers a wide code set across intestinal, hepatic, and pancreatic procurement and transplantation. Backbench preparation codes (47143 through 47147, 48551, 48552) are commonly missed or under-coded in transplant billing. Check that your charge capture protocol includes the full procurement and preparation workflow, not just the transplant itself. |
| 6 | If your program does both cadaver and living donor intestinal transplants, talk to your compliance officer now. The two-track coverage model — deceased donor covered, living donor not — creates billing complexity. Your compliance officer needs to know how this applies to your specific case mix and documentation workflows before you submit any post-February 24 claims. |
| 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 Selection 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 (configuration 1) |
| 47144 | CPT | Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation (configuration 2) |
| 47145 | CPT | Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation (configuration 3) |
| 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 | Considered Not Medically Necessary by Cigna Healthcare |
| 44136 | CPT | Intestinal allotransplantation; from living donor | Considered Not Medically Necessary by Cigna Healthcare |
No ICD-10-CM codes were listed in the MM 0288 policy data. This post will be updated if Cigna publishes diagnosis code-level criteria.
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