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

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