Billing for Transplant Donor related services

It is my understanding that for Donor related services, charges should be captured and held until the Transplant occurs. Then the Donor charges should be included with the Tranplant recipient claim with a 815 Rev Code.

However, I am seeking clarification as to whether charges for services that occur for a Donor that is an unsuccessful match. Should the charges for services provided to a potential Donor that results as an unsuccessful match also be included on the Transplant recipient claim using an 814 Rev Code or should they be adjusted and just included on the cost report?

Thanks in advance.


  • Yes, all donor search charges, including those incurred for working up a donor that does not turn out to be a match, are to be reported on the transplant recipient's claim. They would be held, aggregated together, and reported in revenue code 0815. Remember that it's crucial to capture and report all actual donor search and cell acquisition charges for allo stem cell transplants because of the cost reimbursement that is available from Medicare.

    Additionally, if you have payers, such as Medicare Advantage and/or Medicaid that base payments off of MS-DRG then you are likely getting underpaid for your allo stem cell transplant cases (unless they have made an adjustment). Medicare has removed donor search and cell acquisition costs from MS-DRG 014 because it provides cost reimbursement for those which means the relative weight/payment for MS-DRG 014 has decreased (by about $12,000). So any payer that bases its payment off of Medicare rates must address how it will pay providers for donor search and cell acquisition.

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