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.
