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    v1.0.30
    OpenPayerPolicy UpdatesTransplantAmeriHealth Caritas Hand Arm Coverage | OpenPayer
    Ask Trek AI about this page
    CurrentAmeriHealth CaritasPolicy CCP.1321

    Hand and arm transplants

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    This policy governs coverage determinations for hand, arm, forearm, and composite tissue allotransplantation. Hand and arm transplants are investigational, not clinically proven, and not medically necessary; plan benefits, applicable law, and case-specific facts also affect determinations.

    Policy Summary
    PayerAmeriHealth Caritas
    PolicyHand and arm transplants
    Policy CodePolicy CCP.1321
    Change TypeReference updateno material coverage change
    Effective DateAug 1, 2026
    Last ReviewAug 1, 2026
    Next Review DateDec 1, 2027
    Key ActionDo not consider hand and arm transplants medically necessary; they are investigational and subject to denial.
    SourceLink
    POLICY UPDATE CHANGES

    The 2026 evidence review added recent systematic reviews and national registry data without changing the coverage policy.

    Not coveredCoverage stance for hand and arm transplants
    65.9%+Reported acute rejection rate in reviewed transplant cohorts
    37Vascularized composite tissue transplants performed through 2024
    21

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    Programs nationally that had performed at least one vascularized composite tissue transplant
    LifelongDuration of immunosuppressive therapy required after hand transplantation

    Coverage Criteria

    Hand and arm transplants

    Hand and arm transplants are not covered as medically necessary.

    Coverage determination: Hand and arm transplants are investigational, not clinically proven, and therefore not medically necessary.

    All other uses of hand and arm transplants are not medically necessary.

    Hand and arm transplants, including all other uses, are considered investigational or not clinically proven and are therefore not medically necessary.

    Related Codes

    Related codesCPT
    20802Replantation, arm (includes surgical neck of humerus through elbow joint), complete amputation.
    20805Replantation, forearm (includes radius and ulna to radial carpal joint), complete amputation.
    20808Replantation, hand (includes hand through metacarpophalangeal joints), complete amputation.
    20999Unlisted procedure, musculoskeletal system, general.
    S2152Solid organ(s), complete or segmental, single organ or combination of organs; deceased or living donor(s), procurement, transplantation, and related complications; including: drugs; supplies; hospitalization with outpatient follow-up; medical/surgical, diagnostic, emergency, and rehabilitative services, and the number of days of pre- and post-transplant care in the global definition.

    Provider Actions and Denial Considerations

    Denial Risk

    Investigational procedure

    Hand and arm transplants are investigational/not clinically proven and, therefore, not medically necessary. Claims for this procedure are subject to denial.

    Denial Risk

    Other uses not medically necessary

    All other uses of hand and arm transplants are not medically necessary.

    Background

    Hand and arm transplantation is a form of vascularized composite tissue allotransplantation involving multiple tissue types, including skin, muscle, tendon, bone, cartilage, fat, nerves, and blood vessels. The procedure is complex and requires intensive rehabilitation and lifelong immunosuppression; although functional gains may be possible, the long-term risk-benefit profile remains uncertain, with substantial risks of rejection and immunosuppression-related complications.

    Definitions

    Composite tissue allotransplantation
    DefinitionThe transfer of vascularized or non-vascularized heterogeneous tissues with different antigenicities from one person to another.
    Hand and arm transplantation
    DefinitionA form of vascularized composite tissue allotransplantation involving transplantation of a hand or arm.

    Center Requirements

    Note

    Perform transplantation at a specialized center

    Guidelines cited by the policy recommend that hand transplantation be performed exclusively in specialized centers with multidisciplinary teams experienced in hand surgery and transplant medicine.

    • Establish special arrangements for clinical governance, consent, and ongoing research.
    Policy Summary
    PayerAmeriHealth Caritas
    PolicyHand and arm transplants
    Policy CodePolicy CCP.1321
    Change TypeReference updateno material coverage change
    Effective DateAug 1, 2026
    Last ReviewAug 1, 2026
    Next Review DateDec 1, 2027
    Key ActionDo not consider hand and arm transplants medically necessary; they are investigational and subject to denial.
    SourceLink
    On This Page
    Coverage CriteriaRelated CodesProvider Actions and Denial ConsiderationsBackgroundDefinitionsCenter Requirements