Organ acquisition services

November 14, 2019

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:

  1. A SAC for acquiring a living donor organ (estimated average charge for services provided to living donors and recipients of living donor organs)
  2. A SAC for acquiring a cadaveric donor organ (estimated average charge for procuring cadaveric organs combined with expected costs of acquiring cadaveric organs from other sources)

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:

  1. Annually, providers should report SAC to Humana Military for organ acquisition costs for the fiscal year.
  2. If, for some reason, the provider is unable to report SAC, TRICARE will use the hospital’s overall operation cost-to-charge ratio to reduce charges.

For more information, see the Organ Acquisition Costs section of the TRICARE Reimbursement Manual, Chapter 1, Section 40