Covered Services

Covered Services A. The Division of Medicaid covers the following solid organ transplant services when medically necessary and prior authorized by a Utilization Management/Quality Improvement Organization (UM/QIO), the Division of Medicaid, or designated entity: 1. Single organs: a) Heart, according to current criteria of the International Society for Heart and Lung Transplantation, b) Intestine, according to current criteria of the American Gastroenterological Association and American Society of Transplantation, c) Liver, according to current criteria of the American Association for the Study of Liver Diseases and the American Society of Transplantation, d) Single lung, according to current criteria of the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation, and e) Bilateral lung, according to current criteria of the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation, 2. Multiple-organs which meet the current criteria according to the respective single organ criteria in Rule 4.2.A.: a) Heart-lung, b) Intestines with other organs, c) Kidney-heart, d) Kidney-pancreas, which only reimburses for the kidney transplant, e) Liver-kidney, and f) Other multi-organs. B. The Division of Medicaid covers kidney transplants when medically necessary with no prior authorization. C. The Division of Medicaid covers bone marrow transplantations, peripheral stem cell transplantations and cornea transplantations when medically necessary with no prior authorization, meets Medicare coverage guidelines and are not experimental or investigational. D. The Division of Medicaid covers all facility and physician charges relating to the procurement of an organ, whether from a cadaver or a living donor. 1. The Division of Medicaid covers donor related charges including, but not limited to, the following: a) A search for matching tissue, bone marrow, or organ, b) The donor’s transportation, c) Charges for the removal, withdrawal, and preservation/storage of the organ or tissue, and d) The donor’s hospitalization. 2. The Division of Medicaid covers medically necessary follow-up care outside of the transplant inpatient hospital admission for the living donor only if the donor is a Mississippi Medicaid beneficiary.