Effective Oct. 28, 2019, TRICARE offers reimbursement for reasonable and necessary organ acquisition services and costs in support of quality organ transplant programs. Under Medicare, Certified Transplant Centers (CTC) and Organ Procurement Organizations (OPO) report these costs using the Centers for Medicare and Medicaid Services (CMS) Forms 2552 and 216. TRICARE will use the Medicare Standard Acquisition Charges (SAC) to determine reimbursement amounts.
The CTC must develop two SAC based on reasonable and necessary organ acquisition costs:
The SAC covers total costs for getting either live or cadaver organs. Solid organ procurement costs must be billed separately with revenue code 081X and Healthcare Common Procedure Coding System (HCPCS) code S2152 to be eligible for reimbursement.
TRICARE reimburses CTCs for organ acquisition one of two ways:
For more information, see the Organ Acquisition Costs section of the TRICARE Reimbursement Manual, Chapter 1, Section 40