MACs Will Decide Liver Transplant Coverage for CA

Medicare administrative contractors (MAC) are in a better position to determine coverage of adult liver transplants for patients with three additional malignancies, according to the Centers for Medicare & Medicaid Services (CMS).

Effective June 21, 2012, MACs acting within their respective jurisdictions may determine coverage for adult liver transplantation for patients with extrahepatic unresectable cholangiocarcinoma (CCA), (2) liver metastases due to a neuroendocrine tumor (NET) or (3) hemangioendothelioma (HAE) when furnished in a facility that meets CMS institutional criteria. All other nationally non-covered malignancies continue to remain nationally non-covered.

Liver transplantation, which is in situ replacement of a patient’s liver with a donor liver, in certain circumstances, may be an accepted treatment for patients with end-stage liver disease due to a variety of causes. The procedure is used in selected patients as a treatment for malignancies, including primary liver tumors and certain metastatic tumors, which are typically rare, but lethal, with very limited treatment options. In addition to the new diagnoses, it has also been used in the treatment of patients with extrahepatic perihilar malignancies. Despite potential short and long-term complications, transplantation may offer the only chance of cure for selected patients while providing meaningful palliation for some others.

Source: CMS Transmittal 2513, Aug. 3, 2012

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One Response to “MACs Will Decide Liver Transplant Coverage for CA”

  1. Dr. Vino C. Mody Jr. says:

    The article is important for determining how Medicare Admisitrative Contractors make decisions about liver transplant patients.

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