Get Kidney Transplant Donor Claims Paid

Medicare allows donor expenses incurred after the death of kidney recipients to be treated as incurred before their death. Some of these claims are being rejected by Medicare systems, however. The Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 6978 to correct this problem for services performed on or after Jan. 1, 2011.
Changes to the Medicare Claims Processing Manual, Pub. 100-4, chapter 3, section 90.1.1 include:

  • Physicians’ services rendered to the living donor and physicians’ services rendered to the transplant recipient are billed in the same manner as all Medicare Part B services are billed.
  • Donor physicians’ services are billed on the claim using the recipient’s Medicare number and reporting modifier Q3 Live kidney donor and related services.
  • Institutional claims that do not require modifiers will be processed when the donor is receiving institutional services related to the donation of the kidney where the transplant recipient has died and the donor receives those services after the recipient’s death.

CMS instructs contractors in Transmittal 2008, CR 6978, not to reprocess previously submitted claims unless brought to their attention.
Provider education article MM6978 also is available on the CMS MLN Matters web page.
Source: TrailBlazerHealth

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