CMS Pub. 100-02, ch. 11, § 140.9

The term Medicare Beneficiary Identifier (MBI) is a general term describing a

beneficiary's Medicare identification number. For purposes of this manual, Medicare

beneficiary identifier references both the Health Insurance Claim Number (HICN) and

the Medicare Beneficiary Identifier (MBI) for certain business areas that will continue to

use the HICN as part of their processes.

The donor of a kidney for a Medicare beneficiary transplant recipient is covered for an

unlimited number of days of care in connection with the kidney removal operation. Days

of inpatient hospital care used by the donor in connection with the kidney removal

operation shall not be charged against either party’s utilization record. However, the

program’s assumption of liability is limited to those donor expenses that are incurred

directly in connection with the kidney donation.

Coverage of kidney donor services includes postoperative recovery services directly

related to the kidney donation. For routine follow-up care, the period of postoperative

recovery ceases when the donor no longer exhibits symptoms related to the kidney

donation. Claims for services rendered more than 3 months after donation surgery will

be reviewed. However, follow-up examinations may be covered up to 6 months after the

donation to monitor for possible complications. The requirement that additional payment

cannot be made for services included in the donor’s kidney removal charge still applies.

Regarding donor follow-up:

Expenses incurred by the transplant hospital for routine donor follow-up care are

included in the transplant hospital’s kidney acquisition cost center.

Follow-up services performed by the operating physician are included in the 90-day

global payment for the surgery. Beyond the 90-day global payment period, follow-up

services are billed to Part B using the recipient’s MBI.

Routine follow-up services billed to Medicare by a physician other than the operating

physician for up to 3 months following donation surgery should be billed under the

recipient’s MBI.

Regarding donor complications:

Expenses incurred for complications that arise with respect to the donor are covered only

if they are directly attributable to the donation surgery. Complications that arise after the

date of the donor’s discharge will be billed under the transplant recipient’s MBI. This is

true of both facility cost and physician services. The Medicare Administrative

Contractor reviews costs for kidney donor complications billed under the transplant

recipient’s MBI.

In all of these situations, the kidney donor is not responsible for co-insurance or

deductible.