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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 9 Physician : 9.2 Services, Benefits, Limitations, and Prior Authorization : 9.2.47 Organ/Tissue Transplants : 9.2.47.5 Liver Transplants

9.2.47.5
9.2.47.5.1
For a client to be considered for coverage of a liver transplant, the medical records for the client must include documentation showing the client is unresponsive to more conventional and/or standard therapies.
Authorization of procedure codes 47133 and 47135 requires medical necessity documentation of liver disease in one of the following categories:

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