Organ transplants
Medicare Coverage Information
Overview
Medicare provides coverage for certain medically necessary organ transplants when performed at Medicare-approved facilities. Coverage typically includes kidney, heart, lung, liver, pancreas, and intestinal transplants, with specific conditions and requirements.
- Medicare covers transplants deemed medically necessary by your doctor
- Transplants must be performed at Medicare-certified transplant centers
- Coverage includes pre-transplant evaluations, the surgical procedure, and post-transplant care
- Some immunosuppressive drugs are covered under Medicare Part B
- Patients may need to meet specific medical criteria for transplant eligibility
- Medicare beneficiaries with End-Stage Renal Disease (ESRD)
- Patients who meet specific medical criteria for transplantation
- Individuals enrolled in Medicare Part A and Part B
- Some Medicare Advantage plans may offer additional transplant coverage
- Medicare Part A covers hospital stays related to transplant surgery
- Medicare Part B covers doctor services and some immunosuppressive medications
- Typically, beneficiaries pay 20% of Medicare-approved costs after meeting the Part B deductible
- Supplemental Medicare plans (Medigap) may help cover additional out-of-pocket expenses
- Not all organ transplants are automatically covered
- Transplants must be considered medically necessary
- Some experimental or non-standard transplant procedures may not be covered
- Patients must use Medicare-approved transplant centers
- Certain pre-existing conditions might affect transplant coverage
- Consult with your healthcare provider about transplant medical necessity
- Verify transplant center Medicare certification
- Contact Medicare at 1-800-MEDICARE to confirm specific coverage details
- Review your specific Medicare plan's transplant coverage
- Discuss potential out-of-pocket costs with your healthcare team
Last updated: 6/15/2025
Quick Information
- Provider
- Medicare
- Last Updated
- 6/15/2025
- Topics
- Medicare organ transplantstransplant coverageMedicare Part AMedicare Part Borgan donation
Related Coverage Topics
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