Effective July 1, 1999, Medicare covered pancreas transplantation when performed
simultaneously with or following a kidney transplant if ICD-9 is applicable, ICD-9-CM
procedure code 55.69. If ICD-10 is applicable, the following ICD-10-PCS codes will be
used:
0TY00Z0,
0TY00Z1,
0TY00Z2,
0TY10Z0.
0TY10Z1, and
0TY10Z2
Pancreas transplantation is performed to induce an insulin independent, euglycemic state
in diabetic patients. The procedure is generally limited to those patients with severe
secondary complications of diabetes including kidney failure. However, pancreas
transplantation is sometimes performed on patients with labile diabetes and hypoglycemic
unawareness.
Medicare has had a policy of not covering pancreas transplantation. The Office of Health
Technology Assessment performed an assessment on pancreas-kidney transplantation in
1994. They found reasonable graft survival outcomes for patients receiving either
simultaneous pancreas-kidney (SPK) transplantation or pancreas after kidney (PAK)
transplantation. For a list of facilities approved to perform SPK or PAK, refer to the
following Web site: https://www.cms.gov/Medicare/Provider-Enrollment-andCertification/CertificationandComplianc/downloads/ApprovedTransplantPrograms.pdf
Billing for Pancreas Transplants
There are no special provisions related to managed care participants. Managed care plans
are required to provide all Medicare covered services. Medicare does not restrict which
hospitals or physicians may perform pancreas transplantation.
