US · guidance
CMS Pub. 100-16, ch. 7, § 70.3.2
Transplant
Another component of the CMS-HCC ESRD model are the transplant factors. CMS pays
for the high one-time cost of a transplant by making payments over three months to cover
the costs for the transplant and the immediate subsequent services.
To estimate the factors for the month of the transplant and the two following months,
CMS uses fee-for-service expenditures in these three months and attributes 50% of the
costs to the first month, and half of the remaining costs to each of the second and third
months following the transplant. The factors are calculated by dividing by the
denominator for the CMS-HCC ESRD model.
CMS will make payment by determining the month of transplant and paying the three
lump sum monthly amounts over the three-month period starting with the transplant
month. The payments are calculated by multiplying the transplant factor by the
applicable State rate. See Chapter 8: Payments to Medicare Advantage Organizations.
History
(Rev. 114, Issued; 06-07-13, Effective: 06- 07-13, Implementation: 06-07-13)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
eeb45eb7efa8c8b648b3af24b7589cadb4fe8f9a641cc7bf5d160e6f5635038b
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