evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
 Post-operative/post -procedure evaluation of donor; and    Preparation and processing of stem cells.   Payment for these acquisition services is included in the MS -DRG payment for the allogeneic stem cell transplant when the transplant occurs in the inpatient setting, and in the OPPS APC payment for the  allogeneic stem cell transplant when the transplant occurs in the outpatient setting.    The Medicare contractor does not make separate payment for these acquisition services, because hospitals may bill and receive payment only for services provided to the Medicare beneficiary who is the recipient of the stem cell transplant and whose illness is being treated with the stem cell transplant.  Unlike the acquisition costs of solid organs for transplant (e.g., hearts and kidneys), which are paid on a reasonable cost basis, acquisition costs for allogeneic stem cells are included in prospective paym ent.  Acquisition charges for stem cell transplants apply only to allogeneic transplants, for which stem cells are obtained from a donor (other than the recipient himself or herself).  Acquisition charges do not apply to autologous transplants (transplanted stem  cells are obtained from the recipient himself or herself), because autologous transplants involve services provided to the beneficiary only (and not to a donor), for which the hospital may bill and receive payment (see Pub. 100- 04, chapter 4, 231.10 and paragraph B of this section  for information regarding billing for autologous stem cell transplants).   2. Effective for Cost Reporting Periods Beginning On or After October 1, 2020  Allogeneic hematopoietic stem cell acquisition costs are as follows:    Registry fees from a national donor registry described in 42 U.S.C. 274k, if applicable, for stem cells from an unrelated donor.    Tissue typing of donor and recipient.    Donor evaluation.    Physician pre -admission/pre -procedure donor evaluation services.    Costs associated with the collection procedure (for example, general routine and special care services, procedure/operating room and other ancillary services, apheresis services), and transportation costs of stem cells if the recipient hospital incurred or paid such costs.   Post-operative/post -procedure evaluation of donor.   Preparation and processing of stem cells derived from bone marrow, peripheral blood stem cells, or cord blood (but not including embryonic stem cells).
(Medicare Claims Processing Manual)
 Preparation and processing of stem cells derived from bone marrow, peripheral blood stem cells, or cord blood (but not including embryonic stem cells).  Effective for cost reporting periods beginning on or after October 1, 2020, a subsection (d) hospital that furnishes an allogeneic hematopoietic stem cell transplant to an individual during such a period, payment to such hospital for hematopoietic stem cell acquisition shall be made on a reasonable cost basis.   Payment for allogeneic hematopoietic stem cell acquisition services continues to be included in the OPPS APC payment when the transplant occurs in the outpatient setting.    Acquisition charges for stem cell transplants apply only to allogeneic transplants, for which stem cells are obtained from a donor (other than the recipient himself or herself). Acquisition charges do not apply to autologous transplants (transplanted stem cells are obtained from the recipient himself or herself), because autologous transplants involve services provided to the beneficiary only (and not to a donor), for which the hospital may bill and receive payment (see Pub. 100- 04, chapter 4, 231.10 and paragraph B of this section  for information regarding billing for autologous stem cell transplants).    B. Billing for Acquisition Services   The hospital bills and shows acquisition charges for allogeneic stem cell transplants based on the status  of the patient (i.e., inpatient or outpatient) when the transplant is furnished.  See Pub. 100- 04, chapter 4, 231.11 for instructions regarding billing for acquisition services for allogeneic stem cell transplants that  are performed in the outpatient setting.  When the allogeneic stem cell transplant occurs in the inpatient setting, allogeneic bone marrow/stem cell acquisition charges shall be billed using revenue code 0815.  Revenue code 0815 (Allogeneic Stem Cell Acquisition/Donor Services) charges should include all services required to acquire stem cells from a donor, as defined above.  Effective for discharges occurring on or after October 1, 2021, such charges are not considered for the IPPS outlier calculation when billed for an allogeneic stem cell transplant.
(Medicare Claims Processing Manual)
On the recipients transplant bill, the hospital reports the acquisition charges, cost report days, and utilization days for the donors hospital stay (if applicable) and/or charges for other encounters in which the stem cells were obtained from the donor.  The donor is covered for medically necessary inpatient hospital days of  care or outpatient care provided in connection with the allogeneic stem cell transplant under Part A.   Expenses incurred for complications are paid only if they are directly and immediately attributable to  the stem cell donation procedure.  The hospital reports the acquisition charges on the billing form for the recipient, as described in the first paragraph of this section.  It does not charge the donor's days of care  against the recipient's utilization record.  For cost reporting purposes, it includes the covered donor days and charges as Medicare days and charges.   The transplant hospital keeps an itemized statement that identifies the services furnished in collecting allogeneic hematopoietic stem cells including all invoices or statements for purchased services for all donors and their service charges.  Records must  be for the person receiving the service (donor or recipient).  Beginning October 1, 2020, for all donor sources, the hospital must identify the prospective recipient and include the recipients Medicare beneficiary identification number. These charges wil l be reflected in the transplant hospital's stem cell/bone marrow acquisition cost center.  For allogeneic stem cell acquisition services in cases that do not result in transplant, due to death of the intended recipient or other causes, hospitals include t he costs associated with the acquisition services on the Medicare cost report.   The hospital shows charges for the transplant itself in revenue center code 0362 or another appropriate cost center.  The hospital shows charges for acquiring allogeneic hematopoietic stem cells for transplant   in revenue code 0815.   90.3.2 - Autologous Stem Cell Transplantation (AuSCT)  (Rev.11348; Issued: 04- 07-22; Effective: 05 -09-22; Implementation: 05 -09-22)  A. - General
(Medicare Claims Processing Manual)
A. - General   Autologous stem cell transplantation (AuSCT ) is a technique for restoring stem cells using the patient's own previously stored cells. AuSCT must be used to effect hematopoietic reconstitution following severely myelotoxic doses of chemotherapy (high dose chemotherapy (HDCT)) and/or radiotherapy use d to treat various malignancies.   If ICD -10-PCS is applicable, use the following Procedure Codes and Descriptions -    30230C0  Transfusion of Autologous Hematopoietic Stem/Progenitor Cells, Genetically Modified into Peripheral Vein, Open Approach  30230G0  Transfusion of Autologous Bone Marrow into Peripheral Vein, Open Approach  30230Y0  Transfusion of Autologous Hematopoietic Stem Cells into Peripheral Vein, Open Approach  30233G0  Transfusion of Autologous Bone Marrow into Peripheral Vein, Percutaneous Approach  30233C0  Transfusion of Autologous Hematopoietic Stem/Progenitor Cells, Genetically Modified into Peripheral Vein, Percutaneous Approach  30233Y0  Transfusion of Autologous Hematopoietic Stem Cells into Peripheral Vein, Percutaneous Approach  30240C0  Transfusion of Autologous Hematopoietic Stem/Progenitor Cells, Genetically Modified into Central Vein, Open Approach  30240G0  Transfusion of Autologous Bone Marrow into Central Vein, Open Approach  30240Y0  Transfusion of Autologous Hematopoietic Stem Cells into Central Vein, Open Approach  30243C0  Transfusion of Autologous Hematopoietic Stem/Progenitor Cells, Genetically Modified into Central Vein, Percutaneous Approach  30243G0  Transfusion of Autologous Bone Marrow into Central Vein, Percutaneous Approach  30243Y0  Transfusion of Autologous Hematopoietic Stem Cells into Central Vein, Percutaneous Approach    NOTE: Please note that effective September 30, 2021 PCS codes for Allogeneic SCT 30230G2,  30230G3, 30230Y2, 30230Y3, 30240G2, 30240G3, 30240Y2, 30240Y3 and PCS codes for Autologous SCT 30230C0, 30230G0, 30230Y0, 30240C0, 30240G0, 30240Y0 are end -dated.
(Medicare Claims Processing Manual)
B. - Covered Conditions   1. Effective for services performed on or after April 28,  1989:   For acute leukemia in remission for patients who have a high probability of relapse and who have no human leucocyte antigens (HLA) -matched, the following diagnosis codes are reported:    If ICD -10-CM is applicable, use the following Diagnosis Codes and Descriptions -   Diagnosis Code  Description  C91.01 Acute lymphoblastic leukemia, in remission  C92.01 Acute myeloblastic leukemia, in remission  C92.41 Acute promyelocytic leukemia, in remission  C92.51 Acute myelomonocytic leukemia, in remission C92.61 Acute myeloid leukemia with 11q23- abnormality in remission  C92.A1 Acute myeloid leukemia with multilineage dysplasia, in remission  C93.01 Acute monoblastic/monocytic leukemia, in remission  C94.01 Acute erythroid leukemia, in remission  C94.21 Acute megakaryoblastic leukemia, in remission  C95.01 Acute leukemia of unspecified cell type, in remission    For resistant non- Hodgkin's lymphomas or those presenting with poor prognostic features following an initial response the following diagnosis codes are reported:   If ICD -10-CM is applicable use the following, code ranges C82.01 -  C85.29, C85.81 -  C86.6, C96.4, and C96.Z -  C96.9.  Recurrent or refractory neuroblastoma (see ICD -10-CM codes Neoplasm by site, malignant for the appropriate diagnosis code)   following ranges are reported: C00 -  C96, and D00 -  D09 Resistant non-  Hodgkins lymphomas); or,  Advanced Hodgkin's disease who have failed conventional therapy and have no HLA -matched donor (ICD -10-CM codes C81.01 -  C81.99).  2. Effective for services performed on or after October 1, 2000:
(Medicare Claims Processing Manual)
2. Effective for services performed on or after October 1, 2000:   Durie -Salmon Stage II or III that fit the following requirement are covered: Newly diagnosed or responsive multiple myeloma (if ICD -10-CM is applicable, diagnosis codes C90.00, C90.01, C90.02, and D47.Z9). This includes those patients with previously untreated disease, those with at least a partial response to prior chemotherapy (defined as a 50% decrease either in measurable paraprotein [serum and/or urine] or in bone marrow infiltration, sustained for at least 1 month), and those in responsive relapse, and adequate cardiac, renal, pulmonary, and hepatic function.  3. Effective for Services On or After March 15,  2005  Effective for services performed on or after March 15, 2005, when recognized clinical risk factors are employed to select patients for transplantation, high- dose melphalan (HDM), together with AuSCT, in treating Medicare beneficiaries of any age group with  primary amyloid light -chain (AL) amyloidosis who meet the following criteria:   Amyloid deposition in 2 or fewer organs ;  and,   Cardiac left ventricular ejection fraction (EF) of 45% or  greater.   NOTE: Please note that effective April 01, 2022 unspecified ICD -10-DX codes C47.9, C72.50, C72.9, C81.91, C81.92, C81.93, C81.94, C81.95, C81.96, C81.97, C81.98, C81.99, C85.91, C85.92, C85.93, C85.94, C85.96, C85.97, C85.98, C85.99, C91.91, C92.91, C93.91, C95.91, C96.20, C96.9  are end -dated.   C.  Non -covered Conditions   Insufficient data exist to establish definite conclusions regarding the efficacy of autologous stem cell transplantation for the following conditions:
(Medicare Claims Processing Manual)
C.  Non -covered Conditions   Insufficient data exist to establish definite conclusions regarding the efficacy of autologous stem cell transplantation for the following conditions:   a)  Acute leukemia not in remission prior to October 1, 2000 ( if ICD -10-CM is applicable, ICD -10-CM codes C91.00, C92.00, C93.00, C94.00, and C95.00)   b) Chronic granulocytic leukemia prior to October 1, 2000 (if ICD -10-CM is applicable, ICD -10-CM code C92.10);   c) Solid tumors prior to October 1, 2000 (other than neuroblastoma) (if ICD -10-CM is applicable, ICD -10-CM codes C00.0  C80.2 and D00.0  D09.9);   d) Multiple myeloma prior to October 1, 2000 (if ICD-10- CM is applicable, ICD -10-CM codes C90.00, C90.01, C90.02 and D47.Z9);  e) Tandem transplantation, on or after October 1, 2000 (if ICD-10- CM is applicable, ICD -10-CM codes C90.00, C90.01, C90.02, and  D47.Z9) ;  f) Non- primary amyloidosis on or after 10/01/00, for all Medicare beneficiaries  g) Primary AL amyloidosis effective October 1, 2000, through March 14, 2005 for Medicare beneficiaries age 64. (if ICD -10-CM is applicable, ICD -10-CM codes E85.4, E85.81, E85.9, and E85.89);                    NOTE: Coverage for conditions other than these specifically designated as covered or non- covered is left to the discretion of the A/B MAC (A).   D. Billing for Autologous Stem Cell Transplantation (AuSCT)
(Medicare Claims Processing Manual)
NOTE: Coverage for conditions other than these specifically designated as covered or non- covered is left to the discretion of the A/B MAC (A).   D. Billing for Autologous Stem Cell Transplantation (AuSCT)  The hospital bills and shows all charges for autologous stem cell harvesting, processing, and transplant procedures based on the status of the patient (i.e., inpatient or outpatient) when the services are furnished. It shows charges for the actual transplant, in revenue center code 0362 or another appropriate cost center. ICD-10-PCS codes are used to identify inpatient procedures.  The HCPCS codes describing autologous stem cell harvesting procedures may be billed and are separately payable under the OPPS when provided in the hospital outpatient setting of care. Autologous harvesting procedures are distinct from the acquisition services described in Pub. 100-04, chapter 4, 231.11 and section 90.3.1-A above for allogeneic stem cell transplants, which include services provided when stem cells are obtained from a donor and not from the patient undergoing the stem cell transplant. The HC PCS codes describing autologous stem cell processing procedures also may be billed and are separately payable under the OPPS when provided to hospital outpatients. Payment for autologous stem cell harvesting procedures performed in the hospital inpatient setting of care, with transplant also occurring in the inpatient setting of care, is included in the MS-DRG payment for the autologous stem cell transplant.  90.4 - Liver Transplants  (Rev. 2513, Issued: 08- 03-12, Effective: 06-21-12, Implementation: 09-04-12)
(Medicare Claims Processing Manual)
90.4 - Liver Transplants  (Rev. 2513, Issued: 08- 03-12, Effective: 06-21-12, Implementation: 09-04-12)  A.  Background  For Medicare coverage purposes, liver transplants are considered medically reasonable and necessary for specified conditions when performed in facilities that meet specific criteria.  Coverage guidelines may be found in Publication 100-03, Section 260.1.  Effective for claims with dates of service June 21, 2012 and later, contractors may, at their discretion cover adult liver transplantation for patients with extrahepatic unresectable cholangiocarcinoma (CCA), (2) liver metastases due to a neuroendocrine tu mor (NET) or (3) hemangioendothelimo (HAE) when furnished in an approved Liver Transplant Center (below).  All other nationally non-covered malignancies continue to remain nationally non- covered.   To review the current list of approved Liver Transplant Centers, see http://www.cms.gov/Medicare/Provider-Enrollment- and-Certification/CertificationandComplianc/Transplant.html  90.4.1 - Standard Liver Acquisition Charge  (Rev. 1, 10- 01-03)  A3-3615.1, A3- 3615.3   Each transplant facility must develop a standard charge for acquiring a cadaver liver from costs it expects to incur in the acquisition of livers.  This standard charge is not a charge that represents the acquisition cost of a specific liver.  Rather, it is a charge that reflects the average cost associated with a liver acquisition.
(Medicare Claims Processing Manual)
Services associated with liver acquisition are billed from the organ procurement organization or, in some cases, the excising hospital to the transplant hospital.  The excising hospital does not submit a billing form to the A/B MAC (A).  The transplant hos pital keeps an itemized statement that identifies the services furnished, the charges, the person receiving the service (donor/recipient), and the potential transplant donor.  These charges are reflected in the transplant hospital's liver acquisition cost center and are used in determining the hospital's standard charge for acquiring a cadaver's liver.  The standard charge is not a charge representing the acquisition cost of a specific liver.  Rather, it is a charge that reflects the average cost associated  with liver acquisition.  Also, it is an all- inclusive charge for all services required in acquisition of a liver, e.g., tissue typing, transportation of organ, and surgeons' retrieval fees.     90.4.2 - Billing for Liver Transplant and Acquisition Services  (Rev.11035, Issued:10- 13-21, Effective: 11 -17-21; Implementation: 11 -17-21)  The inpatient claim is completed in accordance with instructions in chapter 25 for the beneficiary who receives a covered liver transplant. Applicable standard liver acquisition charges are identified separately by revenue code 081X. Where interim bills ar e submitted, the standard acquisition charge appears on the billing form for the period during which the transplant took place. This charge is in addition to the hospital's charge for services furnished directly to the Medicare recipient.  The contractor deducts liver acquisition charges for IPPS hospitals prior to processing through Pricer. Costs of liver acquisition incurred by approved liver transplant facilities are not included in the liver transplant prospective payment. They are paid on a reasonable cost basis. This item is a "pass -through" cost for which interim payments are made. (See the Provider Reimbursement Manual, Part 1, 2802 B.8.) The contractor includes liver acquisition charges under revenue code 081X in the HUIP record tha t it sends to CWF and the QIO.   MCE Interface   The MCE contains a limited coverage edit for liver transplant procedures using below ICD -10-CM codes if ICD-10-CM is applicable.    Nationally Covered Diagnosis Codes
(Medicare Claims Processing Manual)
MCE Interface   The MCE contains a limited coverage edit for liver transplant procedures using below ICD -10-CM codes if ICD-10-CM is applicable.    Nationally Covered Diagnosis Codes   Diagnosis  Code   Description  B16.0  Acute hepatitis B with delta -agent with hepatic coma  B16.1  Acute hepatitis B with delta -agent without hepatic coma  B16.2  Acute hepatitis B without delta -agent with hepatic coma  B16.9  Acute hepatitis B without delta -agent and without hepatic coma
(Medicare Claims Processing Manual)
B17.0  Acute delta -(super) infection of hepatitis B carrier  B17.10  Acute hepatitis C without hepatic coma  B17.11  Acute hepatitis C with hepatic coma  B17.2  Acute hepatitis E  B17.8  Other specified acute viral hepatitis  B17.9  Acute viral hepatitis, unspecified  B18.0  Chronic viral hepatitis B with delta -agent  B18.1  Chronic viral hepatitis B without delta -agent  B18.2  Chronic viral hepatitis C  B18.8  Other chronic viral hepatitis  B18.9  Chronic viral hepatitis, unspecified  B19.0  Unspecified viral hepatitis with hepatic coma  B19.10  Unspecified viral hepatitis B without hepatic coma  B19.11  Unspecified viral hepatitis B with hepatic coma  B19.20  Unspecified viral hepatitis C without hepatic coma  B19.21  Unspecified viral hepatitis C with hepatic coma  B19.9  Unspecified viral hepatitis without hepatic coma  C22.0  Liver cell carcinoma  E70.1  Other hyperphenylalaninemias  E70.20  Disorder of tyrosine metabolism, unspecified  E70.21  Tyrosinemia  E70.29  Other disorders of tyrosine metabolism  E70.30  Albinism, unspecified  E70.310  X-linked ocular albinism  E70.311  Autosomal recessive ocular albinism  E70.318  Other ocular albinism  E70.319  Ocular albinism, unspecified  E70.320  Tyrosinase negative oculocutaneous albinism  E70.321  Tyrosinase positive oculocutaneous albinism  E70.328  Other  oculocutaneous albinism  E70.329  Oculocutaneous albinism, unspecified  E70.330  Chediak -Higashi syndrome  E70.331  Hermansky -Pudlak syndrome  E70.338  Other albinism with hematologic abnormality  E70.339  Albinism with hematologic abnormality, unspecified  E70.39  Other specified albinism  E70.40  Disorders of histidine metabolism, unspecified  E70.41  Histidinemia  E70.49  Other disorders of histidine metabolism  E70.5  Disorders of tryptophan metabolism  E70.81  Aromatic L -amino acid decarboxylase deficiency  E70.89  Other disorders of aromatic amino -acid metabolism  E70.9  Disorder of aromatic amino -acid metabolism,
(Medicare Claims Processing Manual)
E70.5  Disorders of tryptophan metabolism  E70.81  Aromatic L -amino acid decarboxylase deficiency  E70.89  Other disorders of aromatic amino -acid metabolism  E70.9  Disorder of aromatic amino -acid metabolism, unspecified  E71.0  Maple -syrup -urine disease  E71.110  Isovaleric acidemia  E71.111  3-methylglutaconic aciduria  E71.118  Other branched -chain organic acidurias  E71.120  Methylmalonic acidemia  E71.121  Propionic acidemia  E71.128  Other disorders of propionate metabolism  E71.19  Other disorders of branched -chain amino -acid metabolism  E71.2  Disorder of branched -chain amino -acid metabolism, unspecified  E71.30  Disorder of fatty -acid metabolism, unspecified  E71.310  Long chain/very long chain acyl CoA dehydrogenase deficiency  E71.311  Medium chain acyl CoA dehydrogenase deficiency  E71.312  Short chain acyl CoA dehydrogenase deficiency  E71.313  Glutaric aciduria type II  E71.314  Muscle carnitine palmitoyltransferase deficiency  E71.318  Other disorders of fatty -acid oxidation  E71.32  Disorders of ketone metabolism  E71.39  Other disorders of fatty-acid metabolism  E71.40  Disorder of carnitine metabolism, unspecified  E71.41  Primary carnitine deficiency  E71.42  Carnitine deficiency due to inborn errors of metabolism  E71.43  Iatrogenic carnitine deficiency  E71.440  Ruvalcaba -Myhre -Smith syndrome  E71.448  Other secondary carnitine deficiency  E71.50  Peroxisomal disorder, unspecified  E71.510  Zellweger syndrome  E71.511  Neonatal adrenoleukodystrophy  E71.518  Other disorders of peroxisome biogenesis  E71.520  Childhood cerebral X -linked adrenoleukodystrophy  E71.521  Adolescent X -linked adrenoleukodystrophy  E71.522  Adrenomyeloneuropathy  E71.528  Other X -linked adrenoleukodystrophy  E71.529  X-linked