HI 00610.345 Organ Transplants

A. Covered procedures

Medicare coverage for major organ transplants varies depending upon the extent to which the transplantation procedure has progressed from the initial, experimental stage in which its safety and effectiveness has not been established to the stage in which its benefits clearly outweigh the risks and its use has become widely accepted by the medical community. The following procedures are generally covered by the Medicare program:

  1. Renal (kidney) transplants.

  2. Heart transplants — when performed in approved hospitals which have met certain criteria that demonstrate the hospital's experience in, and commitment to, heart transplantation.

  3. Liver transplants — for children under age 18 with extrahepatic biliary atresia.

  4. Bone marrow transplants for leukemia, aplastic anemia, severe combined immunodeficiency disease and Wiscott-Aldrich syndrome.

B. Noncovered procedures

The following procedures are not covered by Medicare because they are considered to be in the experimental stage of development:

  1. Combined heart and lung transplants.

  2. Liver transplants for adults.

  3. Pancreas transplants.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600610345
HI 00610.345 - Organ Transplants - 07/14/2014
Batch run: 07/14/2014
Rev:07/14/2014