About this policy
CMS National Coverage Determination | ncd_id=71 | manual_section=260.2 | coverage_level_code=2 | national_coverage_type=True | under_review=False | lab_ncd=False
Coverage indications
Liver transplantation is covered for children (under age 18) with extrahepatic biliary atresia or any other form of end stage liver disease, except that coverage is not provided for children with a malignancy extending beyond the margins of the liver or those with persistent viremia. Liver transplantation is covered for Medicare beneficiaries when performed in a pediatric hospital that performs pediatric liver transplants if the hospital submits an application which CMS approves documenting that: The hospital's pediatric liver transplant program is operated jointly by the hospital and another facility that has been found by CMS to meet the institutional coverage criteria in the "Federal Register" notice of April 12, 1991; The unified program shares the same transplant surgeons and quality assurance program (including oversight committee, patient protocol, and patient selection criteria); and The hospital is able to provide the specialized facilities, services, and personnel that are required by pediatric liver transplant patients.
Documentation requirements
Revision History: 09/1991 - Reiterated coverage policy and provided instructions for applying to become an approved pediatric liver transplant facility. Effective date 04/12/1991. (TN 52) Benefit Categories: 35 - Inpatient Hospital Services; 52 - Physicians' Services Transmittal: transmittal_number=52 | transmittal_issue_date=1991-09-01
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
Backwork has no codes on record for this policy. Check the source.