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 SACs 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 from inpatient claim with revenue codes 0811 or 0812 to be eligible for reimbursement.
TRICARE reimburses CTCs for organ acquisition one of two ways:
Use this SAC form to gather your information to submit to us.
For more information, see the Organ Acquisition Costs section of the TRICARE Reimbursement Manual, Chapter 1, Section 40
NOTE: If your point-of-contact information has changed, please send those updates to HMHSPricingMailbox@humana.com