015 Form

1

Medical Policy Lung and Lobar Lung Transplant Table of Contents • Policy: Commercial • Coding Information
• Information Pertaining to All Policies
• Policy: Medicare • Description
• References
• Authorization Information • Policy History

Policy Number: 015

BCBSA Reference Number: 7.03.07 (For Plan internal use only) NCD/LCD: NA Related Policies
• Heart/Lung Transplant, #269 • Outpatient Pulmonary Rehabilitation, #136 Policy Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity
Medicare HMO BlueSM and Medicare PPO BlueSM Members

Lung transplantation may be considered MEDICALLY NECESSARY for carefully selected individuals with irreversible, progressively disabling, end-stage pulmonary disease unresponsive to maximum medical therapy.

Lobar lung transplant from a living or deceased donor may be considered MEDICALLY NECESSARY for carefully selected individuals with end-stage pulmonary disease.

Etiologies of End-Stage Lung Disease • Bilateral bronchiectasis • Alpha-1 antitrypsin deficiency • Primary pulmonary hypertension • Cystic fibrosis (both lungs to be transplanted) • Bronchopulmonary dysplasia • Postinflammatory pulmonary fibrosis • Idiopathic/interstitial pulmonary fibrosis • Sarcoidosis • Scleroderma • Lymphangiomyomatosis • Emphysema • Eosinophilic granuloma • Bronchiolitis obliterans

2 • Recurrent pulmonary embolism • Pulmonary hypertension due to cardiac disease • Chronic obstructive pulmonary disease • Eisenmenger’s syndrome.

Lung or lobar lung transplants in individuals with any of the following conditions are NOT MEDICALLY NECESSARY:

1. Known active malignancy, including metastatic cancer
2. Recently treated malignancy with a high risk of recurrence Note: the assessment of risk of recurrence of a recently treated malignancy is made by the transplant team; providers must submit a statement with an explanation of why the patient with a recently treated malignancy is an appropriate candidate for a transplant.
3. Untreated systemic infection making immunosuppression unsafe, including chronic infection
4. Other irreversible end-stage disease not attributed to lung disease
5. History of cancer with a moderate risk of recurrence
6. Systemic disease that could be exacerbated by immunosuppression
7. Psychosocial conditions or chemical dependence affecting the ability to adhere to therapy
8. Coronary artery disease not amenable to percutaneous intervention or bypass grafting, or associated with significant impairment of left ventricular function, or

9. Colonization with highly resistant or highly virulent bacteria, fungi, or mycobacteria.

   Lung or lobar lung retransplantation after a failed lung or lobar lung transplant may be considered MEDICALLY NECESSARY in patients who meet criteria for lung transplantation.

   Lung or lobar lung transplantation is considered INVESTIGATIONAL in all other situations.

   Prior Authorization Information
   Inpatient • For services described in this policy, precertification/preauthorization IS REQUIRED for all products if the procedure is performed inpatient.
   Outpatient • For services described in this policy, see below for products where prior authorization might be required if the procedure is performed outpatient.

   Outpatient Commercial Managed Care (HMO and POS) This procedure is performed in the inpatient setting. Commercial PPO and Indemnity This procedure is performed in the inpatient setting. Medicare HMO BlueSM This procedure is performed in the inpatient setting. Medicare PPO BlueSM This procedure is performed in the inpatient setting.

   CPT Codes / HCPCS Codes / ICD Codes Inclusion or exclusion of a code does not constitute or imply member coverage or provider reimbursement. Please refer to the member’s contract benefits in effect at the time of service to determine coverage or non-coverage as it applies to an individual member.

   Providers should report all services using the most up-to-date industry-standard procedure, revenue, and diagnosis codes, including modifiers where applicable.

   The following codes are included below for informational purposes only; this is not an all-inclusive list.

   The above medical necessity criteria MUST be met for the following codes to be covered for Commercial Members: Managed Care (HMO and POS), PPO, Indemnity, Medicare HMO Blue and Medicare PPO Blue:

3 CPT Codes
CPT codes: Code Description 32851 Lung transplant, single; without cardiopulmonary bypass 32852 Lung transplant, single; with cardiopulmonary bypass 32853 Lung transplant, double (bilateral sequential or en bloc); without cardiopulmonary bypass 32854 Lung transplant, double (bilateral sequential or en bloc); with cardiopulmonary bypass HCPCS Codes HCPCS codes: Code Description S2060 Lobar lung transplantation ICD-10 Procedure Codes ICD-10-CM Diagnosis codes: Code Description 0BYC0Z0 Transplantation of Right Upper Lung Lobe, Allogeneic, Open Approach 0BYC0Z1 Transplantation of Right Upper Lung Lobe, Syngeneic, Open Approach 0BYD0Z0 Transplantation of Right Middle Lung Lobe, Allogeneic, Open Approach 0BYD0Z1 Transplantation of Right Middle Lung Lobe, Syngeneic, Open Approach 0BYF0Z0 Transplantation of Right Lower Lung Lobe, Allogeneic, Open Approach 0BYF0Z1 Transplantation of Right Lower Lung Lobe, Syngeneic, Open Approach 0BYG0Z0 Transplantation of Left Upper Lung Lobe, Allogeneic, Open Approach 0BYG0Z1 Transplantation of Left Upper Lung Lobe, Syngeneic, Open Approach 0BYH0Z0 Transplantation of Lung Lingula, Allogeneic, Open Approach 0BYH0Z1 Transplantation of Lung Lingula, Syngeneic, Open Approach 0BYJ0Z0 Transplantation of Left Lower Lung Lobe, Allogeneic, Open Approach 0BYJ0Z1 Transplantation of Left Lower Lung Lobe, Syngeneic, Open Approach 0BYK0Z0 Transplantation of Right Lung, Allogeneic, Open Approach 0BYK0Z1 Transplantation of Right Lung, Syngeneic, Open Approach 0BYL0Z0 Transplantation of Left Lung, Allogeneic, Open Approach 0BYL0Z1 Transplantation of Left Lung, Syngeneic, Open Approach 0BYM0Z0 Transplantation of Bilateral Lungs, Allogeneic, Open Approach 0BYM0Z1 Transplantation of Bilateral Lungs, Syngeneic, Open Approach

DESCRIPTION Solid organ transplantation offers a treatment option for patients with different types of endstage organ failure that can be lifesaving or provide significant improvements to a patient’s quality of life.1, Many advances have been made in the last several decades to reduce perioperative complications. Available data supports improvement in long-term survival as well as improved quality of life particularly for liver, kidney, pancreas, heart, and lung transplants. Allograft rejection remains a key early and late complication risk for any organ transplantation. Transplant recipients require life-long immunosuppression to prevent rejection. Patients are prioritized for transplant by mortality risk and severity of illness criteria developed by the Organ Procurement and Transplantation Network (OPTN) and United Network of Organ Sharing.

Lung Transplant In 2024, 48,136 transplants were performed in the United States procured from more than 41,000 deceased donors and 6900 living donors.2, Lung transplants were the fourth most common procedure with 3,339 transplants performed from both deceased and living donors in 2024.

End-stage lung disease may derive from different etiologies. The most common indications for lung transplantation are chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, cystic fibrosis, a1-

4 antitrypsin deficiency, and idiopathic pulmonary arterial hypertension. Before consideration for transplant, patients should be receiving maximal medical therapy, including oxygen supplementation, or surgical options, such as lung volume reduction surgery for chronic obstructive pulmonary disease. Lung or lobar lung transplantation is an option for patients with end-stage lung disease despite these measures.

A lung transplant refers to single-lung or double-lung replacement. In a single-lung transplant, only 1 lung from a deceased donor is provided to the recipient. In a double-lung transplant, both the recipient's lungs are removed and replaced by the donor's lungs. In a lobar transplant, a lobe of the donor's lung is excised, sized appropriately for the recipient's thoracic dimensions, and transplanted. Donors for lobar transplant have primarily been living-related donors, with 1 lobe obtained from each of 2 donors (generally friends or family members) in cases for which bilateral transplantation is required. There are also cases of cadaver lobe transplants.

Potential recipients who are 12 years of age and older are ranked according to the Lung Allocation Score.3, A score may range between 0 and 100 and incorporates predicted survival after transplantation and predicted survival on the waiting list; the Lung Allocation Score takes into consideration the patient's disease and clinical parameters. The waiting list incorporates the Lung Allocation Score, geography, and blood type classifications. Children younger than 12 years old receive priority for lung allocation. Under this system, children younger than 12 years old with respiratory lung failure and/or pulmonary hypertension who meet criteria are considered "priority 1", and all other candidates in the age group are considered "priority 2". A lung review board has the authority to adjust scores on appeal for adults and children.

Potential Contraindications to Transplantation

Malignancy Malignancies are common after lung transplantation, with 21% and 40% of patients reporting 1 or more malignancies at 5 and 10 years posttransplantation, respectively.4, Skin cancer occurred most frequently, and lymphoproliferative disorders were the malignancies most associated with morbidity posttransplantation.

Human Immunodeficiency Virus Infection Current OPTN policy permits human immunodeficiency virus (HIV)-positive transplant candidates. The 2020 US Public Health Service guideline also allows for transplantations in HIV-positive recipients with proper screenings and effective regimens for HIV infections; it recommended that all transplant candidates receive HIV, hepatitis b virus (HBV), and hepatitis C virus (HCV) testing during hospital admission for transplant surgery.5, In 2022, the US Public Health Service published updated guidance for testing transplant candidates aged less than 12 years of age.6, They recommended that children less than 12 years of age who have received postnatal infectious disease testing are exempt from repeat pretransplant HIV, HBV, and HCV testing during hospital admission for transplant surgery.

The British HIV Association and the British Transplantation Society (2017) updated their guidelines on kidney transplantation in patients with HIV disease.7, These criteria for adding a patient to the waitlist may be extrapolated to other organs: • Adherent with treatment, particularly antiretroviral therapy; • Cluster of Differentiation 4 count greater than 100 cells/mL (ideally >200 cells/mL) for at least 3 months; • Undetectable HIV viremia (<50 HIV-1 RNA copies/mL) for at least 6 months; • No opportunistic infections for at least 6 months; • No history of progressive multifocal leukoencephalopathy, chronic intestinal cryptosporidiosis, or lymphoma.

Other Infections Infection with Burkholderia cenocepacia is associated with increased mortality in some transplant centers, a factor that may be considered when evaluating the overall risk of transplant survival.8, Two articles have evaluated the impact of infection with various species of Burkholderia on outcomes for lung transplantation for cystic fibrosis. In a study by Murray et al (2008), multivariate Cox survival models were applied to 1026 lung transplant candidates and 528 transplant recipients.9, Of the transplant recipients, 88 were infected

5 with Burkholderia. Among transplant recipients infected with B. cenocepacia, only those infected with nonepidemic strains (n=11) had significantly greater posttransplant mortality than uninfected patients (hazard ratio [HR], 2.52; 95% confidence interval [CI], 1.04 to 6.12; p=.04). Transplant recipients infected with Burkholderia gladioli (n=14) also had significantly greater posttransplant mortality than uninfected patients (HR , 2.23; 95% CI, 1.05 to 4.74; p=.04). When adjustments for specific species or strains were included, the Lung Allocation Scores of Burkholderia multivorans-infected transplant candidates were comparable with uninfected candidate scores, and scores for patients infected with nonepidemic B. cenocepacia or B. gladioli were lower. In a smaller study of 22 patients colonized with Burkholderia cepacia complex who underwent lung transplantation in 2 French centers, Boussaud et al (2008) reported that the risk of death by univariate analysis was significantly higher for the 8 patients infected with B. cenocepacia than for the other 14 colonized patients (11 of whom had B. multivorans).10,

An analysis of international registry data by Yusen et al (2016) found that non-cytomegalovirus (CMV) infection is a major cause of mortality within 30 days of a lung transplant in adults.11, A total of 655 (19%) of 3424 deaths after transplants between 1990 and 2015 were due to non-CMV infection. Only 3 (0.1%) of the deaths were due to CMV infection.

Summary A lung transplant consists of replacing all or part of diseased lungs with healthy lung(s) or lobes. Transplantation is an option for individuals with end-stage lung disease.

Summary of Evidence For individuals who have end-stage pulmonary disease who receive a lung transplant, the evidence includes case series and registry studies. Relevant outcomes are overall survival (OS), change in disease status, and treatment-related mortality and morbidity. International registry data on a large number of patients receiving lung transplantation (>50,000) found relatively high patient survival rates, especially among those who survived the first year posttransplant. After adjusting for potential confounding factors, survival did not differ significantly after single- or double-lung transplant. Lung transplantation may be the only option for some patients with end-stage lung disease. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome. For individuals who have end-stage pulmonary disease who receive a lobar lung transplant, the evidence includes case series and systematic reviews. Relevant outcomes are OS, change in disease status, and treatment-related mortality and morbidity. There are less data on lung lobar transplants than on whole- lung transplants, but several case series have reported reasonably similar survival outcomes between the procedures, and lung lobar transplants may be the only option for patients unable to wait for a whole-lung transplant. A 2017 systematic review found 1-year survival rates in available published studies ranging from 50% to 100%. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome. For individuals with a prior lung or lobar transplant who meet criteria for a lung transplant and receive a lung or lobar lung retransplant, the evidence includes case series and registry studies. Relevant outcomes are OS, change in disease status, and treatment-related mortality and morbidity. Data from registries and case series have found favorable outcomes with lung retransplantation in patients who meet criteria for initial lung transplantation. Given the exceedingly poor survival prognosis without retransplantation of patients who have exhausted other treatments, the evidence of a moderate level of posttransplant survival may be considered sufficient in this patient population. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.

Policy History Date Action 11/2025 Annual policy review. Policy updated with literature review through July 28, 2025; reference added. Policy statements unchanged. 10/2024 Annual policy review. Policy updated with literature review through June 18, 2024; no references added. Policy statements unchanged.

6 10/2023 Annual policy review. Description, summary, and references updated. Policy statements unchanged. 10/2022 Annual policy review. references added. Minor editorial refinements to policy statements; intent unchanged. 9/2021 Annual policy review. Policy statements unchanged. 10/2020 Annual policy review. Description, summary, and references updated. Policy statement(s) unchanged. 10/2019 Annual policy review. Description, summary, and references updated. Policy statement(s) unchanged. 10/2018 Annual policy review. Description, summary, and references updated. Policy statement(s) unchanged. 10/2018 Annual policy review. No changes to policy statements. New references added. Summary clarified. 1/2018 Clarified coding information. 10/2017 Annual policy review. Conditions for covered indications moved to Policy Guidelines.
10/1/2017 8/2015 Added coding language. 3/2015 Annual policy review. New references added 10/2014 Coding information clarified. 6/2014 Annual policy review. New medically necessary and investigational indications described. Effective 6/1/2014. 5/2014 Updated Coding section with ICD10 procedure and diagnosis codes. Effective 10/2015. 12/2013 Removed ICD-9 diagnosis codes as the policy requires prior authorization 6/2013 Annual policy review. In lobar lung statement, “children and adolescents” replaced with “carefully selected patients.” Effective 6/1/2013. 11/2011-4/2012 Medical policy ICD 10 remediation: Formatting, editing and coding updates.
No changes to policy statements.
10/2011 Reviewed - Medical Policy Group – GI, Nutrition and Organ Transplantation. No changes to policy statements.
3/2011 Annual policy review. Changes to policy statement.
11/2010 Reviewed - Medical Policy Group – Gastroenterology, Nutrition and Organ Transplantation. No changes to policy statements. 11/2009 Reviewed - Medical Policy Group – Gastroenterology, Nutrition and Organ Transplantation. No changes to policy statements. 9/2009 Annual policy review. No changes to policy statements. 6/2009 Annual policy review. No changes to policy statements.
11/2008 Reviewed - Medical Policy Group – Gastroenterology, Nutrition & Organ Transplants, No changes to policy statements. 5/2008 Annual policy review. Policy guidelines updated. No changes to policy statements.
11/2007 Reviewed - Medical Policy Group – Gastroenterology, Nutrition and Organ Transplants. No changes to policy statements. 11/2006 Reviewed - Medical Policy Group – Gastroenterology, Nutrition and Organ Transplants. No changes to policy statements. Information Pertaining to All Blue Cross Blue Shield Medical Policies Click on any of the following terms to access the relevant information: Medical Policy Terms of Use Managed Care Guidelines Indemnity/PPO Guidelines Clinical Exception Process Medical Technology Assessment Guidelines

7 References

1. Black CK, Termanini KM, Aguirre O, et al. Solid organ transplantation in the 21 st century. Ann Transl Med. Oct 2018; 6(20): 409. PMID 30498736
2. Transplant trends. United Network for Organ Sharing website. Updated July 28, 2025. https://unos.org/data/transplant-trends/. Accessed July 28, 2025.
3. Organ Procurement and Transplantation Network (OPTN). Policy 10: Allocation of Lungs. Updated June 26, 2025; https://optn.transplant.hrsa.gov/media/1200/optn_policies.pdf. Accessed July 27, 2025.
4. Yusen RD, Christie JD, Edwards LB, et al. The Registry of the International Society for Heart and Lung Transplantation: Thirtieth Adult Lung and Heart-Lung Transplant Report--2013; focus theme: age. J Heart Lung Transplant. Oct 2013; 32(10): 965-78. PMID 24054805
5. Jones JM, Kracalik I, Levi ME, et al. Assessing Solid Organ Donors and Monitoring Transplant Recipients for Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Infection - U.S. Public Health Service Guideline, 2020. MMWR Recomm Rep. Jun 26 2020; 69(4): 1-16. PMID 32584804
6. Free RJ, Levi ME, Bowman JS, et al. Updated U.S. Public Health Service Guideline for testing of transplant candidates aged 12 years for infection with HIV, hepatitis B virus, and hepatitis C virus - United States, 2022. Am J Transplant. Sep 2022; 22(9): 2269-2272. PMID 36039545
7. Working Party of the British Transplantation Society. Kidney and Pancreas Transplantation in Patients with HIV. Second Edition (Revised). British Transplantation Society Guidelines. Macclesfield, UK: British Transplantation Society; 2017.
8. Alexander BD, Petzold EW, Reller LB, et al. Survival after lung transplantation of cystic fibrosis patients infected with Burkholderia cepacia complex. Am J Transplant. May 2008; 8(5): 1025-30. PMID 18318775
9. Murray S, Charbeneau J, Marshall BC, et al. Impact of burkholderia infection on lung transplantation in cystic fibrosis. Am J Respir Crit Care Med. Aug 15 2008; 178(4): 363-71. PMID 18535253
10. Boussaud V, Guillemain R, Grenet D, et al. Clinical outcome following lung transplantation in patients with cystic fibrosis colonised with Burkholderia cepacia complex: results from two French centres. Thorax. Aug 2008; 63(8): 732-7. PMID 18408050
11. Yusen RD, Edwards LB, Dipchand AI, et al. The Registry of the International Society for Heart and Lung Transplantation: Thirty-third Adult Lung and Heart-Lung Transplant Report-2016; Focus Theme: Primary Diagnostic Indications for Transplant. J Heart Lung Transplant. Oct 2016; 35(10): 1170-1184. PMID 27772669
12. Paraskeva MA, Edwards LB, Levvey B, et al. Outcomes of adolescent recipients after lung transplantation: An analysis of the International Society for Heart and Lung Transplantation Registry. J Heart Lung Transplant. Mar 2018; 37(3): 323-331. PMID 28320631
13. Goldfarb SB, Levvey BJ, Edwards LB, et al. The Registry of the International Society for Heart and Lung Transplantation: Nineteenth Pediatric Lung and Heart-Lung Transplantation Report-2016; Focus Theme: Primary Diagnostic Indications for Transplant. J Heart Lung Transplant. Oct 2016; 35(10): 1196-1205. PMID 27772671
14. Thabut G, Christie JD, Kremers WK, et al. Survival differences following lung transplantation among US transplant centers. JAMA. Jul 07 2010; 304(1): 53-60. PMID 20606149
15. Black MC, Trivedi J, Schumer EM, et al. Double lung transplants have significantly improved survival compared with single lung transplants in high lung allocation score patients. Ann Thorac Surg. Nov 2014; 98(5): 1737-41. PMID 25110334
16. Yu H, Bian T, Yu Z, et al. Bilateral Lung Transplantation Provides Better Long-term Survival and Pulmonary Function Than Single Lung Transplantation: A Systematic Review and Meta-analysis. Transplantation. Dec 2019; 103(12): 2634-2644. PMID 31283687
17. Yusen RD, Shearon TH, Qian Y, et al. Lung transplantation in the United States, 1999-2008. Am J Transplant. Apr 2010; 10(4 Pt 2): 1047-68. PMID 20420652
18. Shafii AE, Mason DP, Brown CR, et al. Too high for transplantation? Single-center analysis of the lung allocation score. Ann Thorac Surg. Nov 2014; 98(5): 1730-6. PMID 25218678
19. Date H. Update on living-donor lobar lung transplantation. Curr Opin Organ Transplant. Oct 2011; 16(5): 453-7. PMID 21836512
20. Eberlein M, Reed RM, Chahla M, et al. Lobar lung transplantation from deceased donors: A systematic review. World J Transplant. Feb 24 2017; 7(1): 70-80. PMID 28280698

8

21. Barr ML, Schenkel FA, Bowdish ME, et al. Living donor lobar lung transplantation: current status and future directions. Transplant Proc. Nov 2005; 37(9): 3983-6. PMID 16386604
22. Date H, Sato M, Aoyama A, et al. Living-donor lobar lung transplantation provides similar survival to cadaveric lung transplantation even for very ill patients†. Eur J Cardiothorac Surg. Jun 2015; 47(6): 967-72; discussion 972-3. PMID 25228745
23. Date H, Shiraishi T, Sugimoto S, et al. Outcome of living-donor lobar lung transplantation using a single donor. J Thorac Cardiovasc Surg. Sep 2012; 144(3): 710-5. PMID 22717276
24. Slama A, Ghanim B, Klikovits T, et al. Lobar lung transplantation--is it comparable with standard lung transplantation?. Transpl Int. Sep 2014; 27(9): 909-16. PMID 24810771
25. Kilic A, Beaty CA, Merlo CA, et al. Functional status is highly predictive of outcomes after redo lung transplantation: an analysis of 390 cases in the modern era. Ann Thorac Surg. Nov 2013; 96(5): 1804- 11; discussion 1811. PMID 23968759
26. Kawut SM. Lung retransplantation. Clin Chest Med. Jun 2011; 32(2): 367-77. PMID 21511096
27. Biswas Roy S, Panchanathan R, Walia R, et al. Lung Retransplantation for Chronic Rejection: A Single- Center Experience. Ann Thorac Surg. Jan 2018; 105(1): 221-227. PMID 29100649
28. Organ Procurement and Transplantation Network (OPTN). National Data. n.d.; https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/. Accessed July 28, 2025.
29. Raghu G, Collard HR, Egan JJ, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. Mar 15 2011; 183(6): 788-824. PMID 21471066
30. Raghu G, Rochwerg B, Zhang Y, et al. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline: Treatment of Idiopathic Pulmonary Fibrosis. An Update of the 2011 Clinical Practice Guideline. Am J Respir Crit Care Med. Jul 15 2015; 192(2): e3-19. PMID 26177183
31. Raghu G, Remy-Jardin M, Richeldi L, et al. Idiopathic Pulmonary Fibrosis (an Update) and Progressive Pulmonary Fibrosis in Adults: An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med. May 01 2022; 205(9): e18-e47. PMID 35486072
32. Meyer KC, Raghu G, Verleden GM, et al. An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome. Eur Respir J. Dec 2014; 44(6): 1479-
33. PMID 25359357
34. Hayes D, Jennerich AL, Coleman RD, et al. Interventional Strategies for Children with Progressive Pulmonary Hypertension Despite Optimal Therapy: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. Feb 2025; 211(2): 157-173. PMID 39531626
35. Leard LE, Holm AM, Valapour M, et al. Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. Nov 2021; 40(11): 1349-1379. PMID 34419372
36. Centers for Medicare & Medicaid. Transplant. Updated June 9, 2025; https://www.cms.gov/Medicare/Provider-Enrollment-and- Certification/CertificationandComplianc/Transplant.html. Accessed July 28, 2025.