Program_Memos / 2001 / AB-01-58

Why This Topic Matters

It helps readers determine whether the memorandum applies to transplant coverage, facility approval, and billing workflows under Medicare. It also provides context for how administrative policy changes were implemented and processed in claims systems.

Article Sections

1. Change Request 1629

   Introduces the memorandum topic and its relationship to a prior transmittal that is being superseded.

2. Coverage

   Describes the national coverage decision framework, the transplant services addressed, and the general criteria used for Medicare coverage. It also summarizes the facility approval concept and related administrative considerations.

3. Approved Transplant Facilities

   Outlines the facility approval standards, reporting expectations, and exception process for centers performing the transplant services described in the memorandum.

4. Payment

   Summarizes Medicare payment handling for hospital and physician services associated with the transplant procedures, including related coding and claims treatment topics.

5. FI Processing Instructions

   Provides intermediary processing guidance for claims adjudication, billing setup, revenue reporting, and related administrative handling.

6. Carrier Processing Instructions

   Provides carrier-side billing and processing guidance for physician claims and related fee schedule updates.

7. Medicare Summary Notice (MSN), Remittance Advice Messages and Notice of Utilization (NOU) Messages

   Lists notice and remittance message references used when claims are denied under the policy.

8. DMERC Processing Instructions

   Addresses processing for immunosuppressive drug claims connected to the transplant services and the associated supplier submission steps.