Other transplants
Medicare Coverage Information
Overview
Medicare provides coverage for certain specialized organ transplants when deemed medically necessary. Coverage typically includes the transplant procedure, associated hospital stays, and some follow-up care, but specific details can vary based on the type of transplant and individual medical circumstances.
- Medicare covers medically necessary transplants performed in Medicare-approved facilities
- Transplant must be considered standard medical treatment for your condition
- Requires prior authorization and documentation from healthcare providers
- Coverage includes surgical procedure, hospital stay, and some post-transplant care
- Some experimental or rare transplants may have limited coverage
- Medicare Part A and Part B beneficiaries
- Patients with qualifying medical conditions
- Referral from primary care physician required
- Must meet specific medical criteria for transplant
- Medicare Part A typically covers hospital stays related to transplants
- Part B covers physician services and some outpatient care
- Beneficiary may be responsible for 20% of Medicare-approved costs
- Annual deductibles and copayments apply
- Supplemental insurance (Medigap) can help cover additional expenses
- Must be performed at Medicare-certified transplant centers
- Transplant must be considered medically necessary
- Some experimental procedures may not be covered
- Lifetime and annual coverage limits may apply
- Requires comprehensive medical documentation
- Consult with your healthcare provider about transplant necessity
- Verify transplant center's Medicare certification
- Obtain detailed pre-authorization documentation
- Contact Medicare directly to confirm specific coverage details
- Review your specific Medicare plan's transplant coverage
Last updated: 6/15/2025
Quick Information
- Provider
- Medicare
- Last Updated
- 6/15/2025
- Topics
- Medicare transplant coverageorgan transplant benefitsMedicare transplant eligibilityspecialized medical transplantsMedicare Part A transplant coverage
Related Coverage Topics
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