§ 413.416 - Organ acquisition charges for kidney-paired exchanges.

§ 413.416 Organ acquisition charges for kidney-paired exchanges.

Cross Reference

Link to an amendment published at 87 FR 72290, Nov. 23, 2022.

(a) Initial living donor evaluations. When a recipient and donor elect to participate in a kidney paired exchange, the costs of the initial living donor evaluations are incurred by the originally intended recipient's transplant hospitalTH, regardless of whether the living donor actually donates to their originally intended recipient, a kidney paired exchange recipient, or does not donate at all.

(b) Additional tests after a match. In a kidney paired exchange, regardless of whether an actual donation occurs, once the donor and recipient are matched, any additional tests requested by the recipient's transplant hospital TH and performed by the donor's transplant hospitalTH, are billed to the recipient's transplant hospital TH as charges reduced to cost (using the donor's transplant hospitalTH's cost to charge ratio) and included as acquisition costs on the recipient transplant hospitalTH's Medicare cost report.

(c) Procurement and transport of a kidney. When a donor's transplant hospital TH procures and furnishes a kidney to a recipient's transplant hospital TH all of the following are applicable:

(1) All costs must be reasonable and necessary.

(2)

(i) The donor's transplant hospital TH bills the recipient's transplant hospitalTH.

(ii) The donor's transplant hospital TH bills its charges reduced to cost, or bills its applicable kidney SAC for the reasonable costs associated with procuring, packaging, and transporting the kidney.

(3) The donor's transplant hospital TH records the costs described in paragraph (c)(2)(ii) of this section on its Medicare cost report as kidney acquisition costs and offsets any payments received from the recipient's transplant hospital TH against its kidney acquisition costs.

(4) The recipient's transplant hospital TH records as part of its kidney acquisition costs -

(i) The amounts billed by the donor's transplant hospital TH for the reasonable costs associated with procuring, packaging, and transporting the organ; and

(ii) Any additional testing performed and billed by the donor's transplant hospitalTH.

(d) Donor's procurement occurs at recipient transplant hospitalTH. In a kidney-paired exchange -

(1) When a donor's transplant hospital TH does not procure a kidney, but the donor travels to the recipient's transplant hospital TH for the organ procurement, the reasonable costs associated with the organ procurement are included on the Medicare cost report of the recipient's transplant hospitalTH; and

(2) The travel expenses of the living donor are not allowable Medicare costs.

[86 FR 73515, Dec. 27, 2021, as amended at 87 FR 72290, Nov. 23, 2022]