Live Kidney Donor Services

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 Medicare number of the recipient
• For services rendered prior to October 1, 2015, we suggest submitting ICD-9-CM code V59.4 as a primary diagnosis
• For services rendered after October 1, 2015, we suggest submitting ICD-10-CM code Z52.4 as a primary diagnosis
• HCPCS modifier Q3

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.

• Pub. 100-02 (PDF), Chapter 11: End Stage Renal Disease
• Pub. 100-04 (PDF), Chapter 8: Outpatient ESRD Hospital, Independent Facility, and Physician/ Supplier Claims
• Pub. 100-04 (PDF), Chapter 16: Laboratory Services
• MLN Matters article MM7520 (PDF,): Clarification of Payment for ESRD-Related Services Under the Monthly Capitation Payment