CurrentCignaPolicy 0107
Pancreatic islet cell transplantation
Defines coverage policy for autologous and allogeneic pancreatic islet cell transplantation and bioartificial pancreas devices for Cigna-administered health benefit plans, including medical necessity determinations, coding, background, literature, and related guidance. This part (1 of 2) includes policy statements, background, professional society positions, literature summaries, FDA information (including Lantidra), and coding lists.
Policy Summary
PayerCigna
PolicyPancreatic islet cell transplantation
Policy CodePolicy 0107
Change TypeFocused & Annual reviews
Effective Date
Next Review Date
Key ActionDocument that the patient is undergoing total or near-total pancreatectomy for severe chronic pancreatitis refractory to standard therapy and is not a type 1 diabetes patient; include evidence that conservative treatments were exhausted and multidisciplinary evaluation occurred.
POLICY UPDATE CHANGES
Focused Review 09/15/2023: Updated allogeneic policy statement with clarifying language.
Annual Review 06/15/2024: No clinical policy statement changes.
Annual Review 06/15/2025: No clinical policy statement changes.
1Covered Indications (autologous TPIAT)
1Not-covered/Experimental (allogeneic, bioartificial)
2023-06-28FDA approval date noted (Lantidra)
NumerousReferences cited