Billing for Donor Post-Kidney Transplant Complication Services

90.1.3 - Billing for Donor Post-Kidney Transplant Complication Services (Rev. 2334, Issued: 10-28-11; Effective: Policy Effective date: November 28, 2011; Claims Processing Effective date: April 1, 2012; Implementation: April 2, 2012) Expenses incurred for complications that arise with respect to the donor are covered and separately billable only if they are directly attributable to the donation surgery. All covered services (both institutional and professional) for complications from a Medicare covered transplant that arise after the date of the donor’s transplant discharge will be billed under the recipient’s health insurance claim number and are billed to the Medicare program in the same manner as all Medicare Part B services are billed. • All covered donor post-kidney transplant complication services must be billed to the account of the recipient (i.e., the recipient's Medicare number) • Modifier Q3 (Live Kidney Donor and Related Services) appears on each covered line of the claim that contains a HCPCS code. Institutional claims will be required to also include: • Occurrence Code 36 (Date of Inpatient Hospital Discharge for covered transplant patients) • Patient Relationship Code 39 (Organ Donor) Contractors shall override Edit 5211 when modifier Q3 appears on claims for donor services it receives when the recipient is deceased (See Pub. 100-02, chapter 11, section 80.4). NOTE: For institutional claims which do not require modifiers, contractors may manually override the CWF edit as necessary.