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.