UM Guidelines
Renal Transplant

Inpatient and Surgical Care (ISC)

BCBST last reviewed November 23, 2016*


There were no deletions.

Added to: Clinical Indications
  • Documentation related to human immunodeficiency virus (HIV) including 1 or more of the following:
    • The individual is negative for human immunodeficiency virus (HIV)
    • The individual is positive for human immunodeficiency virus (HIV), but has no advancing / symptomatic HIV disease as indicated by ALL the following:
      • CD4 count >200 cells per cubic millimeter for >6 months
      • HIV-1 RNA undetectable
      • Stable anti-retroviral therapy >3 months
      • Absence of complications from AIDS (e.g. opportunistic infections, including aspergillus, tuberculosis, coccidiosis mycosis, resistant fungal infections Kaposi’s sarcoma or other neoplasm)


BlueCross BlueShield Association. Medical Policy Reference Manual. (6:2015). Kidney Transplant (7.03.01) Retrieved July 8, 2015 from BlueWeb. (17 articles and/or guidelines reviewed)

BlueCross BlueShield of Tennessee network physicians. August - September 2016.



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