Normally, various tests are performed to determine the type and suitability of a cadaver
kidney. Such tests may be performed by the excising hospital (which may also be a
transplant hospital) or an independent laboratory. When the excising-only hospital
performs the tests, it includes the related charges on its bill to the transplant hospital or to
the organ procurement agency.
When the tests are performed by the transplant hospital, it uses the related costs in
establishing the standard charge for acquiring the cadaver kidney. The transplant hospital
includes the costs and charges in the appropriate departments for final cost settlement
purposes.
The cost of these services cannot be billed directly to the program, since such tests and
other procedures performed on a cadaver are not identifiable to a specific patient.
Billing For Physicians' Services Prior to Transplantation
Physicians' services applicable to kidney excisions involving live donors and recipients
(during the pre-entitlement period and after entitlement, but prior to entrance into the
hospital for transplantation) as well as all physicians' services applicable to cadavers are
considered Part A hospital services (kidney acquisition costs).
Billing for Physicians' Services After Transplantation
All physicians' services rendered to the living donor and all physicians' services rendered
to the transplant recipient are billed to the Medicare program in the same manner as all
Medicare Part B services are billed. All donor physicians' 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 the claim. For services performed on or after
January 1, 2011 CWF shall allow Edit 5211 to be overridden at the contractor level. Also,
contractors shall override Edit 5211 when this modifier appears on claims for donor
services it receives when the recipient is deceased
