Does S2152 require prior authorization?

No, S2152 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for S2152?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`S2152`, Solid organ(s), complete or segmental, single organ or combination of organs;

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Clinical documentation of NYHA class (for ≥18 years) or AHA stage (for <18 years)
Documentation/clinical evidence estimating life expectancy in the absence of cardiopulmonary disease (≥2 years)
For HIV‑positive candidates: documentation of CD4 count >200 cells/mm³ for at least 3 months prior to transplantation to be considered for exception to contraindication
Documentation of current/effective antiretroviral therapy (ART) if member is HIV-positive
Documentation demonstrating absence of chronic wasting or severe malnutrition
Documentation confirming absence of active extrapulmonary or disseminated infection (culture/results/clinical notes).

Key Coverage Criteria

Age ≥ 18 years with both end-stage heart disease and end-stage lung disease (heart-lung transplantation is medically necessary when both conditions are present)
Irreversible primary pulmonary hypertension with severe heart failure.
Nonspecific idiopathic severe pulmonary fibrosis.
Eisenmenger syndrome with irreversible pulmonary hypertension and heart failure.
Cystic fibrosis with severe heart failure.
Chronic obstructive pulmonary disease with severe heart failure.

20 Active Policies

AMBETTER-CP.MP.132, Heart-Lung Transplant

AMBETTER-CP.MP.58, Intestinal and Multivisceral Transplant

AMBETTER-CP.MP.57, Lung Transplantation

AMBETTER-CP.MP.246, Pediatric Kidney Transplant

AMBETTER-CP.MP.120, Pediatric Liver Transplant

BCBSIL-SUR703.006, Heart/Lung Transplant

BCBSIL-SUR703.014, Isolated Small Bowel Transplant

BCBSIL-SUR703.007, Kidney Transplant

BCBSIL-SUR703.008, Liver Transplant and Combined Liver-Kidney Transplant

BCBSIL-SUR703.010, Lung and Lobar Lung Transplant

BCBSIL-SUR703.009, Small Bowel/Liver and Multivisceral Transplant

BCBSMT-SUR703.006, Heart/Lung Transplant

BCBSMT-SUR703.014, Isolated Small Bowel Transplant

BCBSMT-SUR703.007, Kidney Transplant

BCBSMT-SUR703.008, Liver Transplant and Combined Liver-Kidney Transplant

BCBSMT-SUR703.010, Lung and Lobar Lung Transplant

BCBSMT-SUR703.009, Small Bowel/Liver and Multivisceral Transplant

BCBSNM-SUR703.006, Heart/Lung Transplant

BCBSNM-SUR703.014, Isolated Small Bowel Transplant

BCBSNM-SUR703.007, Kidney Transplant

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S2152, Solid organ(s), complete or segmental, single organ or combination of organs;

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Clinical documentation of NYHA class (for ≥18 years) or AHA stage (for <18 years)
Documentation/clinical evidence estimating life expectancy in the absence of cardiopulmonary disease (≥2 years)
For HIV‑positive candidates: documentation of CD4 count >200 cells/mm³ for at least 3 months prior to transplantation to be considered for exception to contraindication
Documentation of current/effective antiretroviral therapy (ART) if member is HIV-positive
Documentation demonstrating absence of chronic wasting or severe malnutrition
Documentation confirming absence of active extrapulmonary or disseminated infection (culture/results/clinical notes).

Key Coverage Criteria

Age ≥ 18 years with both end-stage heart disease and end-stage lung disease (heart-lung transplantation is medically necessary when both conditions are present)
Irreversible primary pulmonary hypertension with severe heart failure.
Nonspecific idiopathic severe pulmonary fibrosis.
Eisenmenger syndrome with irreversible pulmonary hypertension and heart failure.
Cystic fibrosis with severe heart failure.
Chronic obstructive pulmonary disease with severe heart failure.

20 Active Policies

AMBETTER-CP.MP.132, Heart-Lung Transplant

AMBETTER-CP.MP.58, Intestinal and Multivisceral Transplant

AMBETTER-CP.MP.57, Lung Transplantation

AMBETTER-CP.MP.246, Pediatric Kidney Transplant

AMBETTER-CP.MP.120, Pediatric Liver Transplant

BCBSIL-SUR703.006, Heart/Lung Transplant

BCBSIL-SUR703.014, Isolated Small Bowel Transplant

BCBSIL-SUR703.007, Kidney Transplant

BCBSIL-SUR703.008, Liver Transplant and Combined Liver-Kidney Transplant

BCBSIL-SUR703.010, Lung and Lobar Lung Transplant

BCBSIL-SUR703.009, Small Bowel/Liver and Multivisceral Transplant

BCBSMT-SUR703.006, Heart/Lung Transplant

BCBSMT-SUR703.014, Isolated Small Bowel Transplant

BCBSMT-SUR703.007, Kidney Transplant

BCBSMT-SUR703.008, Liver Transplant and Combined Liver-Kidney Transplant

BCBSMT-SUR703.010, Lung and Lobar Lung Transplant

BCBSMT-SUR703.009, Small Bowel/Liver and Multivisceral Transplant

BCBSNM-SUR703.006, Heart/Lung Transplant

BCBSNM-SUR703.014, Isolated Small Bowel Transplant

BCBSNM-SUR703.007, Kidney Transplant

Have a follow-up question?

Ask Backwork about documentation requirements, denial risks, or coverage in your state.

Ask Backwork about S2152 Sign up free

`S2152`, Solid organ(s), complete or segmental, single organ or combination of organs;

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`S2152`, Solid organ(s), complete or segmental, single organ or combination of organs;

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

S2152, Solid organ(s), complete or segmental, single organ or combination of organs;

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

S2152, Solid organ(s), complete or segmental, single organ or combination of organs;

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`S2152`, Solid organ(s), complete or segmental, single organ or combination of organs;

`S2152`, Solid organ(s), complete or segmental, single organ or combination of organs;