US · guidance
CMS Pub. 100-04, ch. 32, § 70.5
Special Billing and Payment Requirements Medicare Advantage (MA)
Beneficiaries
(Rev. 261, Issued: 07-30-04, Effective: 10-01-04, Implementation: 10-04-04)
CMS will make payment directly on a fee-for service basis for the routine costs of pancreatic islet cell
transplants as well as transplantation and appropriate related items and services, for MA beneficiaries
participating in an NIH-sponsored clinical trial. MA organizations will not be liable for payment for routine
costs of this new clinical trial until MA payments can be appropriately adjusted to take into account the cost of
this national coverage decision. Medicare contractors shall make payment on behalf of MA organizations
directly to providers of these islet cell transplants in accordance with Medicare payment rules, except that
beneficiaries are not responsible for the Part A and Part B deductibles. MA enrollees will be liable for any
applicable coinsurance amounts MA organizations have in place for clinical trial benefits.
E10.649 Type 1 diabetes mellitus with hypoglycemia without coma
E10.8 Type 1 diabetes mellitus with unspecified complications
History
(Rev. 261, Issued: 07-30-04, Effective: 10-01-04, Implementation: 10-04-04)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
44c488ac4f7a87e7f944c40462e096c49a54bbc2cc8513b493ea0c9c36c32105
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