Billing for Kidney Transplant and Acquisition Services

90.1.2 - Billing for Kidney Transplant and Acquisition Services (Rev.: 13757; Issued: 04-30-26; Effective: 04-01-26; Implementation: 04-06-26) Applicable standard kidney acquisition charges are identified separately by revenue code 0811 (Living Donor Kidney Acquisition) or 0812 (Cadaver Donor Kidney Acquisition). Where interim bills are submitted, the standard acquisition charge appears on the billing form for the period during which the transplant took place. This charge is in addition to the hospital's charges for services rendered directly to the Medicare recipient. The contractor deducts kidney acquisition charges for PPS hospitals for processing through Pricer. These costs, incurred by approved kidney transplant hospitals, are not included in the kidney transplant prospective payment. They are paid on a reasonable cost basis. Interim payment is paid as a "pass through" item. (See the Provider Reimbursement Manual, Part 1, §2802 B.8.) The contractor includes kidney acquisition charges under the appropriate revenue code in CWF. Bill Review Procedures The Medicare Code Editor (MCE) creates a Limited Coverage edit for kidney transplant procedure codes. Where these procedure codes are identified by MCE, the shared system checks the provider number to determine if the provider is an approved transplant center, and checks the effective approval date. The shared system shall also determine if the facility is certified for adults and/or pediatric transplants and Return To Provider (RTP) as appropriate. If payment is appropriate (i.e., the center is approved and the service is on or after the approval date) it overrides the limited coverage edit.