2.1 Cadaver
and living donor kidney transplantation is covered when the transplant
is performed at a Medicare-certified kidney transplantation center
(pediatric consortia are not applicable for kidney transplantation
at this time), for beneficiaries who:
2.1.1 Are suffering from concomitant,
irreversible renal failure; and
2.1.2 Have exhausted more conservative
medical and surgical treatment; and
2.1.3 Have plans for long-term adherence
to a disciplined medical regimen that are feasible and realistic.
2.3 Services and supplies related
to kidney transplantation are covered for:
2.3.1 Evaluation of potential candidate’s
suitability for kidney transplantation, whether or not the patient
is ultimately accepted as a candidate for transplantation.
2.3.2 Pre- and
post-transplant inpatient hospital and outpatient services.
2.3.3 Pre- and
post-operative services of the transplant team.
2.3.4 The donor
acquisition team, including the costs of transportation to the location
of the donor organ and transportation of the team and the donated
organ to the location of the transplantation center.
2.3.5 The maintenance
of the viability of the donor organ after all existing legal requirements
for excision of the donor organ have been met.
2.3.6 Donor costs.
2.3.7 Blood and
blood products.
2.3.8 U.S. Food and Drug Administration
(FDA) approved immunosuppression drugs to include off-label uses
when reliable evidence documents that the off-label use is safe,
effective and in accordance with nationally accepted standards of
practice in the medical community (proven).
2.3.9 Complications
of the transplant procedure, including inpatient care, management
of infection and rejection episodes.
2.3.10 Periodic
evaluation and assessment of the successfully transplanted patient.
2.3.11 Transportation
of the patient by air ambulance and the services of a certified
life support attendant.
2.3.12 Deoxyribonucleic
Acid-Human Leucocyte Antigen (DNA-HLA) tissue typing determining histocompatibility.