Heart-Lung Transplant
Governs clinical policy guidance for referral, selection, and coverage considerations for heart-lung transplantation for members of the Health Plan; intended for providers and administrators involved in transplant care and benefit determinations.
No material clinical or coverage changes in this revision.
Coverage Criteria
Coverage decisions and the administration of benefits under this policy are governed by the member's contract and the Health Plan's terms. Coverage is subject to all applicable terms, conditions, exclusions, and limitations of the member's coverage documents and to applicable law and regulation; this policy itself does not guarantee payment. When state Medicaid provisions conflict with this clinical policy, state Medicaid coverage provisions take precedence. The Health Plan retains the right to change, amend, or withdraw this clinical policy at any time.
Provider Actions and Notices
Medicare coverage cross-check
For Medicare members/enrollees, providers must review all applicable Medicare National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and Medicare Coverage Articles prior to applying the criteria in this clinical policy. Refer to the CMS website at http://www.cms.gov for additional information.
Follow coverage documents and legal/regulatory requirements
This clinical policy is a guide to medical necessity and does not replace provider professional judgment. Providers must follow applicable coverage documents, the member contract, state and federal requirements, and any applicable state Medicaid manual. Where state Medicaid provisions conflict with this clinical policy, the state Medicaid provisions take precedence. Providers are responsible for ensuring compliance with legal and regulatory requirements.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.