Transplant Billing

Can anyone offer a recommendation of an educational resource to assist in learning billing rules related to Transplant services? Education is sought for basics and learning as to what charges are reported with the Transplant encounter vs a separate encounter. The focus is BMT transplants not organ transplants.  Also trying to learn what types of services for cellular infusions are considered under the same rules as a BMT.  Do the same billing rules for donor acquisition charges being reported with the BMT transplant recipient claim apply for Donor Lymphocyte Infusions when the infused product are allogenic donor cells.  Any references are greatly appreciated.


  • The NMDP/Be the Match website has resources that describe the billing rules for allo and auto stem cell and bone marrow transplants. The rules are complex and not intuitive since Medicare requires that all of the donor search and cell acquisition charges be held and reported on the recipient's transplant claim which may not occur for months after other services have been rendered to potential donors like HLA testing/typing, E/M etc. Recall you can never bill a donor but instead have to hang on to all of these charges using the recipient's insurance as the guarantor and have these accounts/charges flagged so that when you have the transplant claim they are all brought over and reported using rev code 815. This is the revenue code required by the NUBC for reporting donor search and cell acquisition charges. You should also make sure you have line 0077 set up in your cost report. These things REALLY matter now that CMS will provide cost reimbursement for ALL donor search and cell acquisition costs. This was a huge win that involved Congress passing legislation and CMS enacting new rules/regs on how it will do this. The first phase of this new way of reimbursing these costs started Oct 1, 2020 and starting Oct 1, 2021, the phase in will be complete. You can also read more about this in CMS' FY 2021 IPPS Final Rule, visiting the NMDP/Be the Match website, or the ASTCT website as there should be free webinars/PPTs on all of this. Just know that stem cell transplant billing is very complex and getting it right takes a village. Not sure what is being asked about cellular infusions but if you are talking about cell therapies, like CAR-T for example, then no the same billing rules do not apply. If you have acquired cells from a donor for a DLI infusion that will be provided to the recipient at a later time, then yes the same billing rules apply since these are donor cells. But you may be asking something different here. Again, check out the NMDP/Be the Match website and join their forum as well since transplant centers ask and answer questions like this there too.

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