Anthem Blue Cross Connecticut TRANS.00040 Hand Transplantation Form

Effective Date

09/27/2023

Last Reviewed

08/10/2023

Original Document

  Reference



TRANS.00040 Hand Transplantation

Subject:

Description/Scope

This document addresses hand transplantation for individuals with an amputated hand. Hand transplantation is a type of vascularized composite allograft (VCA) allogenic transplantation involving multiple tissue types such as skin, connective tissue, blood vessels, bone, muscle and nerves. The goal of hand transplantation is functional restoration, rather than survival.

Note: Please see the following related document for additional information:

  • CG-OR-PR-05 Myoelectric Upper Extremity Prosthetic Devices

Position Statement

Investigational and Not Medically Necessary:

Hand transplantation is considered investigational and not medically necessary.