Transplant Services

Billing and Reimbursement
Policy Number: RP-X-003

Last Updated: Feb. 28, 2022 

Coverage for transplant donor-related services will vary depending on the BCBSNE covered person’s contract. Under some contracts, donor-related services are only covered if the transplant recipient is also covered by BCBSNE, and donor-related services are not covered if the transplant recipient is not covered by BCBSNE. Under other BCBSNE member contracts, if the donor and the recipient are both covered under the same policy, covered services will be processed under the recipient.       

Member eligibility and benefits must be verified.      

Bone Marrow / Stem Cell Transplants: 

All donor-related services for allogeneic bone marrow/stem cell transplants must be billed with revenue code 819. All donor-related services for autologous bone marrow/stem cell transplants can be billed either with revenue code 819 or under the appropriate revenue code based on the services performed (i.e., 300 for lab, 320 for X-ray, etc.).       

Cadaver Donor: Donor services must be billed under revenue code 812 for all cadaver donor transplants.       

Donor Maximums: Please check with BCBSNE Provider Services, as coverage and restrictions may vary.       

Living Donor: Donor services must be billed under revenue code 811 for all living donor transplants. Living donor services must be billed with a donor diagnosis and must include the donor name and relationship to the transplant recipient in Field Locator (FL) 80 of the UB-04 or in Box 19 of the CMS 1500 claim form.       

In addition, Box 6 of the CMS 1500 claim form must indicate “Other.” The name of the donor is needed to avoid possible duplicate denials since there may be more than one potential donor. These claims must be submitted as paper claims; when submitted electronically, they will be denied as duplicates. 

Nebraska Organ Retrieval Services (NORS): NORS performs the service of removal of organs from patients that have expired to be used for transplants. Reimbursement for these services should be provided to the hospital and must not be submitted to either the patient’s family or to BCBSNE.    

Search Activation: C232overage for search activation fees is dependent on the member’s contract with BCBSNE.