Kidney Transplantation

140 - Kidney Transplantation (Rev. 13599, Issued: 01-30-26, Effective: 05-01-26, Implementation: 05-01-26) A3-3178, RDF-230 Introduction Kidney transplantation is the preferred form of treatment for patients with ESRD. Medicare has developed a method of payment for the variety of medical services required to support a kidney transplant program, including payment for Medicare’s share of the costs of kidney procurement. See 42 CFR § 413.400, et seq. for Medicare’s organ acquisition payment regulations. In addition, Medicare has developed coverage and payment criteria for medically necessary services provided to potential kidney donors and recipients. In some situations, these services are provided before the effective date of Medicare entitlement for the potential kidney transplant recipient. Medicare pays for the covered services provided to a Medicare patient who receives a kidney transplant from a living or deceased donor. Expenses in providing kidneys to a transplant hospital (TH) (a transplant program within a hospital that meets that meets Medicare conditions of participation) or organ procurement organization (OPO) are included in the TH’s living or deceased donor kidney acquisition cost center, or the OPO’s kidney acquisition cost center, respectively. To participate in the Medicare program, any TH or OPO must be a member of the Organ Procurement and Transplantation Network (OPTN). Hospitals are required to notify the OPO designated for their service areas of individuals whose death is imminent or who have died in the hospital (See 42 CFR § 482.45(a)(1) for notification requirements, and 42 CFR § 413.404, for rules pertaining to THs and OPOs in developing a living and deceased donor standard acquisition charge for organs.) See the OPTN Web site at https://optn.transplant.hrsa.gov/about/search-membership/ to search for transplant hospitals, including hospitals that have kidney transplant programs.