For Medicare coverage purposes, liver transplants are considered medically reasonable
and necessary for specified conditions when performed in facilities that meet specific
criteria.
Effective for claims with dates of service June 21, 2012 and later, contractors may, at their
discretion cover adult liver transplantation for patients with extrahepatic unresectable
cholangiocarcinoma (CCA), (2) liver metastases due to a neuroendocrine tumor (NET) or
(3) hemangioendothelimo (HAE) when furnished in an approved Liver Transplant Center (below). All other nationally non-covered malignancies continue to remain nationally
non-covered.
Standard Liver Acquisition Charge
Each transplant facility must develop a standard charge for acquiring a cadaver liver from
costs it expects to incur in the acquisition of livers.
This standard charge is not a charge that represents the acquisition cost of a specific liver.
Rather, it is a charge that reflects the average cost associated with a liver acquisition.
Services associated with liver acquisition are billed from the organ procurement
organization or, in some cases, the excising hospital to the transplant hospital. The
excising hospital does not submit a billing form to the A/B MAC (A). The transplant
hospital keeps an itemized statement that identifies the services furnished, the charges, the
person receiving the service (donor/recipient), and the potential transplant donor. These
charges are reflected in the transplant hospital's liver acquisition cost center and are used
in determining the hospital's standard charge for acquiring a cadaver's liver. The standard
charge is not a charge representing the acquisition cost of a specific liver. Rather, it is a
charge that reflects the average cost associated with liver acquisition. Also, it is an allinclusive
charge for all services required in acquisition of a liver, e.g., tissue typing,
transportation of organ, and surgeons' retrieval fees.
