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Islet Cell Transplantation

Section: Surgery
Effective Date: December 31, 2019
Revised Date: December 31, 2019
Last Reviewed: January 22, 2020

Description

Islet cell allotransplantation: Islet cells are isolated from the pancreas of a cadaver donor, purified and transplanted into the recipient via the portal vein or one of the tributaries into the liver, where they take up residence and resume function.

Islet cell autotransplantation: During the pancreatectomy procedure, a suspension of isolated islet cells is created from the recipient’s resected pancreas specimen and then injected in the portal vein of the liver where the cells function as a free graft.

Criteria

Islet cell autotransplantation may be considered medically necessary when performed for ANY of the following indications:

  • Total pancreatectomy for patients with chronic pancreatitis with disabling pain; or
  • Subtotal pancreatectomy for patients with chronic pancreatitis with disabling pain.

Islet cell autotransplantation for all other indications/conditions is considered experimental/investigational and therefore non-coveredbecause the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.

Procedure Codes

48160

Islet cell allotransplantation for the treatment of Type I diabetes mellitus (IDDM) is considered experimental/investigational and therefore non-coveredbecause the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.

Procedure Codes

0584T 0585T 0586T G0341 G0342 G0343 S2102

Diagnosis Codes

K86.0 K86.1

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