R9-22-206. Organ and Tissue Transplant Services

A. Organ and tissue transplant services are covered for a member if prior authorized and coordinated with the member’s contractor, or the Administration. Only the following transplants are covered for individuals 21 years of age or older: 1. Heart, including transplants for the treatment of non-ischemic cardiomyopathy; 2. Liver, including transplants for patients with hepatitis C; 3. Kidney (cadaveric and live donor); 4. Simultaneous Pancreas/Kidney (SPK); 5. Autologous and Allogeneic related and unrelated Hematopoietic Cell transplants; 6. Cornea; 7. Bone; 8. Lung; and 9. Pancreas after a kidney transplant (PAK). B. The following transplants are not covered for members 21 years of age or older: 1. Pancreas only transplants if it is not performed simultaneously with or following a kidney transplant. Partial pancreas transplants and autologous and allogeneic pancreas islet cell transplants are not covered even if performed simultaneously with or following a kidney transplant, 2. Intestine transplants, and 3. Any other type of transplant not specifically listed in subsection (A). C. When there is a transplant of multiple organs, reimbursement will only be made for those covered. D. Organ and tissue transplant services are not covered for nonqualified aliens or noncitizens members of FESP under A.R.S. § 36-2903.03(D).