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ACG

h.o.l.M.E.S.

Automated Clinical Guidelines

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Transplant Services

Indicates Non-covered Service
Transplantation (Mesencephalic, Adrenal-Brain and Fetal Xenograft)
Vascularized Composite Allograft (VCA) Transplantation
Anthem
Cigna

32850, 32851, 32852, 32853, 32854, 33927, 33928, 33929, 33935, 33945, 38230, 38232, 38240, 38241, 38243, 47135, 48160, 48550, 48554, 48556, 50360, 50365, 50370, 81370, 81371, 81372, 81373, 81374, 81375, 81376, 81377, 81378, 81379, 81380, 81381, 81382, 81383, 81595, 0494T, 0495T,0496T, 0584T, 0585T, 0586T, L8698, S9975,

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Thymus Tissue Transplantation 
Cigna
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