TMPPM 2008 > Texas Medicaid Services > Renal Dialysis Facility > Benefits and Limitations

40.3.2 Kidney Transplants

Medicare coverage of a client who requires a kidney transplant can begin as early as the month in which a client is hospitalized for transplantation, provided the surgery takes place in that month or in the following two months. Medicare coverage of a client who receives a successful kidney transplant ends with the thirty-sixth month after the transplant. At that time, Medicaid resumes full coverage of the client's claims for services covered under the Texas Medicaid Program, if the client remains eligible for Texas Medicaid.

If HHSC verifies that a Medicaid client is not eligible for Medicare coverage of a transplant, the Texas Medicaid Program pays for the transplantation services. Medicaid does not pay for donor expenses. Facility expenses for kidney procurement, tissue matching, or the cost of maintaining a kidney before transplantation are included in the diagnosis-related group (DRG) reimbursement.

Medicare benefits for qualified clients include all covered Part A and B items and services. Coverage is not limited to items and services associated with renal disease. Medicaid coverage of Medicare clients extends to the Medicare deductible and coinsurance. Medicaid may pay the Medicare deductible and coinsurance for clients who are eligible.

Refer to: "Organ/Tissue Transplants" and "Organ/Tissue Transplant Services" for information on organ transplant and facility services.