There are two basic standard charges that must be developed by transplant hospitals from
costs expected to be incurred in the acquisition of kidneys:
The standard charge for acquiring a live donor kidney; and
The standard charge for acquiring a cadaver kidney.
The standard charge is not a charge representing the acquisition cost of a specific kidney;
rather, it is a charge that reflects the average cost associated with each type of kidney
acquisition.
When the transplant hospital bills the program for the transplant, it shows its standard
kidney acquisition charge on revenue code 081X. Kidney acquisition charges are not
considered for the IPPS outlier calculation.
Acquisition services are billed from the excising hospital to the transplant hospital. A
billing form is not submitted from the excising hospital to the FI. The transplant hospital
keeps an itemized statement that identifies the services furnished, the charges, the person
receiving the service (donor/recipient), and whether this is a potential transplant donor or
recipient. These charges are reflected in the transplant hospital's kidney acquisition cost
center and are used in determining the hospital's standard charge for acquiring a live
donor's kidney or a cadaver's kidney. The standard charge is not a charge representing the
acquisition cost of a specific kidney. Rather, it is a charge that reflects the average cost
associated with each type of kidney acquisition. Also, it is an all-inclusive charge for all
services required in acquisition of a kidney, i.e., tissue typing, post-operative evaluation.
A. - Billing For Blood And Tissue Typing of the Transplant Recipient Whether or
Not Medicare Entitlement Is Established
Tissue typing and pre-transplant evaluation can be reflected only through the kidney
acquisition charge of the hospital where the transplant will take place. The transplant
hospital includes in its kidney acquisition cost center the reasonable charges it pays to the
independent laboratory or other hospital which typed the potential transplant recipient,
either before or after his entitlement. It also includes reasonable charges paid for
physician tissue typing services, applicable to live donors and recipients (during the preentitlement
period and after entitlement, but prior to hospital admission for
transplantation).
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