decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Program_Memos / 2002 / AB-02-040
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Article Overview
This article summarizes a CMS Program Memorandum that reissues earlier guidance on intestinal and multi-visceral transplantation. It covers the Medicare coverage framework, approved transplant facility requirements, payment-related notes, and carrier/intermediary processing instructions. The memo is intended for Medicare contractors, transplant facilities, and claims-processing staff who need to understand the scope and implementation timing of the policy.
Why This Topic Matters
It explains how Medicare operationalized coverage and billing for a specialized transplant service, including the facility criteria and claim-processing handling needed for compliant administration.
Article Sections
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Change Request 1629
Identifies the subject of the memorandum and explains that it reprints and supersedes earlier related guidance.
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Coverage
Describes the national coverage framework, the effective date of coverage, broad clinical context, and general facility expectations for the service.
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Approved Transplant Facilities
Outlines the standards for facility approval, reporting expectations, and the process for submitting applications and receiving approval.
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Payment
Summarizes the payment framework, related diagnosis and procedure coding references, and general transplant reimbursement considerations.
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FI Processing Instructions
Provides intermediary processing guidance for claims handling, billing classification, and related administrative steps.
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Carrier Processing Instructions
Provides carrier-side billing instructions for physician claims and identifies claim submission considerations for transplant-related services.
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Medicare Summary Notice (MSN), Remittance Advice Messages and Notice of Utilization (NOU) Messages
Lists notification and denial-message guidance for claims affected by facility or coverage limitations.
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DMERC Processing Instructions
Addresses processing of immunosuppressive drug claims and the associated supplier documentation requirements.
What You Will Learn
- How this CMS memo frames Medicare coverage for intestinal and multi-visceral transplantation
- What general approval and reporting topics apply to transplant facilities
- What categories of payment and claims-processing guidance the memo addresses
- Which administrative contractors and claim-processing functions are affected
- What implementation and discard timing information is included
Who Should Read This
- Medicare intermediaries
- Medicare carriers
- DMERCs
- Transplant facility administrators
- Hospital billing and coding staff
- Physician billing staff
- Medicare claims processors
Codes Discussed
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