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TRICARE Policy Manual 6010.60-M, April 1, 2015
Chapter 4
Section 24.9
Donor Costs
Issue Date:  October 27, 1995
Authority:  32 CFR 199.4(e)(5)
Revision:  
1.0  POLICY
1.1  Donor costs are covered when:
1.1.1  Both the donor and recipient are beneficiaries.
1.1.2  The donor is a beneficiary but the recipient is not.
Note:  This policy does not supersede the provisions of Title 10, United States Code (USC) Chapter 55, Section 1079, which stipulates that TRICARE is always second pay, except to Medicaid. If the recipient has Other Health Insurance (OHI), the OHI is primary payor for donor costs. TRICARE will cover donor costs when the recipient does not have OHI or the donor costs are not covered by the OHI. (See the TRICARE Reimbursement Manual (TRM), Chapter 4, Section 4.)
1.1.3  The donor is the sponsor and the recipient is the beneficiary. (In such an event, donor costs are paid as a part of the beneficiary and recipient costs.)
1.1.4  The donor is neither a beneficiary nor a sponsor, if the recipient is a beneficiary. (Again, in such an event, donor costs are paid as a part of the beneficiary and recipient costs.)
1.2  If the donor is not a beneficiary, TRICARE benefits for donor costs are limited to those directly related to the transplant procedure itself and do not include any medical care costs related to other treatment of the donor, including complications.
1.3  In most instances, for costs related to isolated kidney transplants, Medicare (not TRICARE) benefits for end-stage renal disease will be applicable.
1.4  If a beneficiary participates as a kidney donor for a Medicare beneficiary, Medicare will pay for expenses in connection with the kidney transplant to include all reasonable preparatory, operation and postoperation recovery expenses associated with the donation.
2.0  EXCLUSIONS
2.1  Services and supplies provided as a part of or under a scientific or medical study, grant, or research program.
2.2  Services and supplies not provided in accordance with accepted professional medical standards; or integral to an unproven procedure.
2.3  Donor transportation costs.
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