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CMS Transmittals



National Coverage Determination
Procedure Code: 8XXXX
Adult Liver Transplantation
CMS Policy Number: 260.1
Back to NCD List



To review all requirements of this policy, please see: CMS NCD listing by Chapter

Covered ICD-10 Codes.

ICD-10Descriptor
B16.0 Acute hepatitis B with delta-agent with hepatic coma
B16.1 Acute hepatitis B with delta-agent without hepatic coma
B16.2 Acute hepatitis B without delta-agent with hepatic coma
B16.9 Acute hepatitis B w/o delta-agent and without hepatic coma
B17.0 Acute delta-(super) infection of hepatitis B carrier
B17.10 Acute hepatitis C without hepatic coma
B17.11 Acute hepatitis C with hepatic coma
B17.2 Acute hepatitis E
B17.8 Other specified acute viral hepatitis
B17.9 Acute viral hepatitis, unspecified
B18.0 Chronic viral hepatitis B with delta-agent
B18.1 Chronic viral hepatitis B without delta-agent
B18.2 Chronic viral hepatitis C
B18.8 Other chronic viral hepatitis
B18.9 Chronic viral hepatitis, unspecified
B19.0 Unspecified viral hepatitis with hepatic coma
B19.10 Unspecified viral hepatitis B without hepatic coma
B19.11 Unspecified viral hepatitis B with hepatic coma
B19.20 Unspecified viral hepatitis C without hepatic coma
B19.21 Unspecified viral hepatitis C with hepatic coma
B19.9 Unspecified viral hepatitis without hepatic coma
C22.0 Liver cell carcinoma
E70.1 Other hyperphenylalaninemias
E70.20 Disorder of tyrosine metabolism, unspecified
E70.21 Tyrosinemia
E70.29 Other disorders of tyrosine metabolism
E70.30 Albinism, unspecified
E70.310 X-linked ocular albinism
E70.311 Autosomal recessive ocular albinism
E70.318 Other ocular albinism
E70.319 Ocular albinism, unspecified
E70.320 Tyrosinase negative oculocutaneous albinism
E70.321 Tyrosinase positive oculocutaneous albinism
E70.328 Other oculocutaneous albinism
E70.329 Oculocutaneous albinism, unspecified
E70.330 Chediak-Higashi syndrome
E70.331 Hermansky-Pudlak syndrome
E70.338 Other albinism with hematologic abnormality
E70.339 Albinism with hematologic abnormality, unspecified
E70.39 Other specified albinism
E70.40 Disorders of histidine metabolism, unspecified
E70.41 Histidinemia
E70.49 Other disorders of histidine metabolism
E70.5 Disorders of tryptophan metabolism
E70.8 Other disorders of aromatic amino-acid metabolism
E70.9 Disorder of aromatic amino-acid metabolism, unspecified
E71.0 Maple-syrup-urine disease
E71.110 Isovaleric acidemia
E71.111 3-methylglutaconic aciduria
E71.118 Other branched-chain organic acidurias
E71.120 Methylmalonic acidemia
E71.121 Propionic acidemia
E71.128 Other disorders of propionate metabolism
E71.19 Other disorders of branched-chain amino-acid metabolism
E71.2 Disorder of branched-chain amino-acid metabolism, unsp
E71.30 Disorder of fatty-acid metabolism, unspecified
E71.310 Long chain/very long chain acyl CoA dehydrogenase deficiency
E71.311 Medium chain acyl CoA dehydrogenase deficiency
E71.312 Short chain acyl CoA dehydrogenase deficiency
E71.313 Glutaric aciduria type II
E71.314 Muscle carnitine palmitoyltransferase deficiency
E71.318 Other disorders of fatty-acid oxidation
E71.32 Disorders of ketone metabolism
E71.39 Other disorders of fatty-acid metabolism
E71.40 Disorder of carnitine metabolism, unspecified
E71.41 Primary carnitine deficiency
E71.42 Carnitine deficiency due to inborn errors of metabolism
E71.43 Iatrogenic carnitine deficiency
E71.440 Ruvalcaba-Myhre-Smith syndrome
E71.448 Other secondary carnitine deficiency
E71.50 Peroxisomal disorder, unspecified
E71.510 Zellweger syndrome
E71.511 Neonatal adrenoleukodystrophy
E71.518 Other disorders of peroxisome biogenesis
E71.520 Childhood cerebral X-linked adrenoleukodystrophy
E71.521 Adolescent X-linked adrenoleukodystrophy
E71.522 Adrenomyeloneuropathy
E71.528 Other X-linked adrenoleukodystrophy
E71.529 X-linked adrenoleukodystrophy, unspecified type
E71.53 Other group 2 peroxisomal disorders
E71.540 Rhizomelic chondrodysplasia punctata
E71.541 Zellweger-like syndrome
E71.542 Other group 3 peroxisomal disorders
E71.548 Other peroxisomal disorders
E72.00 Disorders of amino-acid transport, unspecified
E72.01 Cystinuria
E72.02 Hartnup's disease
E72.03 Lowe's syndrome
E72.04 Cystinosis
E72.09 Other disorders of amino-acid transport
E72.10 Disorders of sulfur-bearing amino-acid metabolism, unsp
E72.11 Homocystinuria
E72.12 Methylenetetrahydrofolate reductase deficiency
E72.19 Other disorders of sulfur-bearing amino-acid metabolism
E72.20 Disorder of urea cycle metabolism, unspecified
E72.21 Argininemia
E72.22 Arginosuccinic aciduria
E72.23 Citrullinemia
E72.29 Other disorders of urea cycle metabolism
E72.3 Disorders of lysine and hydroxylysine metabolism
E72.4 Disorders of ornithine metabolism
E72.50 Disorder of glycine metabolism, unspecified
E72.51 Non-ketotic hyperglycinemia
E72.52 Trimethylaminuria
E72.53 Primary hyperoxaluria
E72.59 Other disorders of glycine metabolism
E72.81 Disorders of gamma aminobutyric acid metabolism
E72.89 Other specified disorders of amino-acid metabolism
E72.9 Disorder of amino-acid metabolism, unspecified
E80.0 Hereditary erythropoietic porphyria
E80.29 Other porphyria
E83.00 Disorder of copper metabolism, unspecified
E83.01 Wilson's disease
E83.09 Other disorders of copper metabolism
E83.110 Hereditary hemochromatosis
E83.111 Hemochromatosis due to repeated red blood cell transfusions
E83.118 Other hemochromatosis
E83.119 Hemochromatosis, unspecified
E85.0 Non-neuropathic heredofamilial amyloidosis
E85.1 Neuropathic heredofamilial amyloidosis
E85.2 Heredofamilial amyloidosis, unspecified
E85.3 Secondary systemic amyloidosis
E85.4 Organ-limited amyloidosis
E85.89 Other amyloidosis
E88.01 Alpha-1-antitrypsin deficiency
E88.02 Plasminogen deficiency
I82.0 Budd-Chiari syndrome
K70.0 Alcoholic fatty liver
K70.10 Alcoholic hepatitis without ascites
K70.11 Alcoholic hepatitis with ascites
K70.2 Alcoholic fibrosis and sclerosis of liver
K70.30 Alcoholic cirrhosis of liver without ascites
K70.31 Alcoholic cirrhosis of liver with ascites
K70.40 Alcoholic hepatic failure without coma
K70.41 Alcoholic hepatic failure with coma
K70.9 Alcoholic liver disease, unspecified
K71.0 Toxic liver disease with cholestasis
K71.10 Toxic liver disease with hepatic necrosis, without coma
K71.11 Toxic liver disease with hepatic necrosis, with coma
K71.2 Toxic liver disease with acute hepatitis
K71.3 Toxic liver disease with chronic persistent hepatitis
K71.4 Toxic liver disease with chronic lobular hepatitis
K71.50 Toxic liver disease w chronic active hepatitis w/o ascites
K71.51 Toxic liver disease w chronic active hepatitis with ascites
K71.6 Toxic liver disease with hepatitis, not elsewhere classified
K71.7 Toxic liver disease with fibrosis and cirrhosis of liver
K71.8 Toxic liver disease with other disorders of liver
K71.9 Toxic liver disease, unspecified
K72.00 Acute and subacute hepatic failure without coma
K72.01 Acute and subacute hepatic failure with coma
K72.10 Chronic hepatic failure without coma
K72.11 Chronic hepatic failure with coma
K72.90 Hepatic failure, unspecified without coma
K72.91 Hepatic failure, unspecified with coma
K73.1 Chronic lobular hepatitis, not elsewhere classified
K73.2 Chronic active hepatitis, not elsewhere classified
K73.8 Other chronic hepatitis, not elsewhere classified
K73.9 Chronic hepatitis, unspecified
K74.0 Hepatic fibrosis
K74.1 Hepatic sclerosis
K74.2 Hepatic fibrosis with hepatic sclerosis
K74.3 Primary biliary cirrhosis
K74.4 Secondary biliary cirrhosis
K74.5 Biliary cirrhosis, unspecified
K74.60 Unspecified cirrhosis of liver
K74.69 Other cirrhosis of liver
K75.0 Abscess of liver
K75.1 Phlebitis of portal vein
K75.2 Nonspecific reactive hepatitis
K75.3 Granulomatous hepatitis, not elsewhere classified
K75.4 Autoimmune hepatitis
K75.81 Nonalcoholic steatohepatitis (NASH)
K75.89 Other specified inflammatory liver diseases
K75.9 Inflammatory liver disease, unspecified
K76.0 Fatty (change of) liver, not elsewhere classified
K76.1 Chronic passive congestion of liver
K76.2 Central hemorrhagic necrosis of liver
K76.3 Infarction of liver
K76.4 Peliosis hepatis
K76.5 Hepatic veno-occlusive disease
K76.6 Portal hypertension
K76.7 Hepatorenal syndrome
K76.81 Hepatopulmonary syndrome
K76.89 Other specified diseases of liver
K76.9 Liver disease, unspecified
K77 Liver disorders in diseases classified elsewhere
K83.01 Primary sclerosing cholangitis
K83.09 Other cholangitis
K83.1 Obstruction of bile duct
K83.5 Biliary cyst
K83.8 Other specified diseases of biliary tract
K83.9 Disease of biliary tract, unspecified
K91.82 Postprocedural hepatic failure
Q44.1 Other congenital malformations of gallbladder
Q44.2 Atresia of bile ducts
Q44.3 Congenital stenosis and stricture of bile ducts
Q44.4 Choledochal cyst
Q44.6 Cystic disease of liver
T86.40 Unspecified complication of liver transplant
T86.41 Liver transplant rejection
T86.42 Liver transplant failure
T86.43 Liver transplant infection
T86.49 Other complications of liver transplant

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