Laparotomy for islet cell transplant, includes portal vein catheterization and infusion
Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)
Medically Unlikely Edits (effective October 1, 2026)
Practitioner: max 1 units per day (policy), rationale: Anatomic Consideration
Outpatient hospital: max 1 units per day (policy), rationale: Anatomic Consideration
Medicare pricing for G0343
Physician Fee Schedule (CY 2026, RVU26D)
Status A: active, paid separately under the PFS if covered. National amounts: non-facility $1,165.02, facility $1,165.02 (total RVUs 34.88 / 34.88 × $33.4009 conversion factor; non-facility NA: rarely or never done in that setting). Work RVU 19.35, practice expense RVU 10.38 non-facility and 10.38 facility, malpractice RVU 5.15. Global period 090. Qualifying APM participants are paid at a $33.5675 conversion factor.
Payer policies and prior authorization for G0343
22 of 22 payer prior-auth lists that name G0343 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Texas, CarePlus Health Plans, Cigna, Humana, Rocky Mountain Health Plans, UnitedHealthcare Community Plan.
G0343 appears in 7 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, Cigna, Premera Blue Cross, Regence.
Payer
Policy
Role in policy
Reviewed
Document
Aetna
Pancreas Transplantation Alone (PTA) and Islet Cell Transplantation (0601)
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.