CMS Pub. 100-02, ch. 11, § 140.5

in Pre-entitlement Period

(Rev. 13599, Issued: 01-30-26, Effective: 05-01-26, Implementation: 05-01-26)

A3-3178.5, RDF-233.1

When a living donor is admitted to a hospital (before admission for excising the donor

kidney) for a medical evaluation in anticipation of a kidney donation, all hospital and

physicians’ services costs applicable to medical evaluation are considered kidney

acquisition service costs. As such, the hospital statistics (charges, patient days, etc.) and

the physicians’ charges should be treated in accordance with all other kidney acquisition

service statistics, and the related costs are included in the Medicare hospital cost report

for kidney acquisition.

When the living donor subsequently enters the hospital for the actual excision, the

hospital costs of services rendered to the donor will continue to be treated as kidney

acquisition costs under Part A. However, at that point physician services are no longer

considered kidney acquisition costs and are not reimbursable under Part A. Instead,

during the living donor’s inpatient stay for the excision surgery and during any

subsequent living donor inpatient stays resulting from a direct complication of the kidney

donation, physician services are billed under Part B. They are billed in the normal

manner but on the account of the Medicare transplant recipient at 100 percent of the fee

schedule. Note that services furnished to living kidney donors are covered under the

Medicare Beneficiary Identifier of the Medicare transplant recipient.

Services listed in the following sections are also covered. However, they are not billed as

such but become a part of the kidney acquisition costs and are included in the kidney

acquisition cost center on the Medicare hospital cost report.