decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Program_Memos / 2000 / AB-00-17
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Article Overview
This 2000 HCFA Program Memorandum clarifies Medicare policy for liver transplantation after a coverage revision tied to hepatitis B-related end-stage liver disease. It is relevant to transplant hospitals, Medicare contractors, and medical reviewers who need to understand the scope of national coverage guidance, areas left to contractor discretion, and when local medical review policies may apply.
Why This Topic Matters
The memorandum helps readers distinguish between national Medicare coverage policy and matters left to contractor judgment in liver transplant cases. It also addresses how transplant-center compliance, retransplantation questions, immunoglobulin coverage questions, and malignancy-related exclusions are handled at a policy level.
Article Sections
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Subject: Clarification of Liver Transplant Policy
Introduces the policy clarification and the context for the questions raised by contractors after a coverage revision.
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Questions and Answers
Presents contractor questions and HCFA responses covering donor-related issues, retransplantation, immunoglobulin coverage, hepatitis-related transplant coverage, malignancy exclusions, and local medical review policies.
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Administrative Information
Lists effective and implementation timing, retention guidance, and contact information for the memorandum.
What You Will Learn
- How the memorandum frames liver transplant coverage under Medicare
- Which liver transplant-related issues are addressed at the national policy level
- Which matters are left to contractor discretion or local review processes
- How the memorandum treats transplant-center compliance and administrative implementation details
Who Should Read This
- Medicare contractors
- Hospital transplant program staff
- Medical coders and reimbursement staff
- Compliance and utilization review professionals
- Health policy researchers
Codes Discussed
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