CMS Pub. 100-04, ch. 3, § 90.1

A3-3612, HO-E414

A major treatment for patients with ESRD is kidney transplantation. This involves removing

a kidney, usually from a living relative of the patient or from an unrelated person who has

died, and surgically placing the kidney into the patient. After the beneficiary receives a

kidney transplant, Medicare pays the transplant hospital for the transplant and appropriate

standard acquisition charges. Special provisions apply to payment. For the list of approved

Medicare certified transplant facilities, refer to the following Web site:

http://www.cms.hhs.gov/CertificationandComplianc/20_Transplant.asp#TopOfPage

A transplant hospital may acquire cadaver kidneys by:

• Excising kidneys from cadavers in its own hospital; and

• Arrangements with a freestanding organ procurement organization (OPO) that

provides cadaver kidneys to any transplant hospital or by a hospital based OPO.

A transplant hospital that is also a certified organ procurement organization may acquire

cadaver kidneys by:

• Having its organ procurement team excise kidneys from cadavers in other hospitals;

• Arrangements with participating community hospitals, whether they excise kidneys

on a regular or irregular basis; and

• Arrangements with an organ procurement organization that services the transplant

hospital as a member of a network.

When the transplant hospital also excises the cadaver kidney, the cost of the procedure is

included in its kidney acquisition costs and is considered in arriving at its standard cadaver

kidney acquisition charge. When the transplant hospital excises a kidney to provide another

hospital, it may use its standard cadaver kidney acquisition charge or its standard detailed

departmental charges to bill that hospital.

When the excising hospital is not a transplant hospital, it bills its customary charges for

services used in excising the cadaver kidney to the transplant hospital or organ procurement

agency.

If the transplanting hospital's organ procurement team excises the cadaver kidney at another

hospital, the cost of operating such a team is included in the transplanting hospital's kidney

acquisition costs, along with the reasonable charges billed by the other hospital of its

services.