Expenses for physicians’ services rendered to a live kidney donor are treated as though the Medicare beneficiary (recipient) had incurred them. Payment for these services is made at 100 percent of the allowed amount. These services include the donor’s pre-operative surgical care, kidney excision inpatient stay and any subsequent related post-operative period. There is no deductible or coinsurance charged for services furnished to live donors.
Claims submitted for the donor must include the following:
- Name, address and Health Insurance Claim (HIC) number of the recipient
- ICD-9 code V59.4 as a primary diagnosis
- HCPCS modifier Q3
- Name and address of the live donor
- Indicate this in the documentation record for electronic claims. If you meet the requirements to submit paper claims, this information must be indicated on a separate attachment to the CMS-1500 claim form.
Since donor services are submitted under the recipient’s Medicare record, it is important that claims are submitted correctly to avoid duplicate denials and claim submission errors.
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