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Medicare program; criteria for Medicare coverage of lung transplants--HCFA. Notice with comment period
Insights
Medicare now covers lung and heart-lung transplants for patients with end-stage cardiopulmonary disease. Coverage is conditional on specific facility and patient criteria being met.
Area of Science:
- Medicine
- Transplantation Surgery
- Public Health Policy
Background:
- Lung and heart-lung transplantation are complex procedures for end-stage disease.
- Medicare coverage policies require clear guidelines for medical necessity.
Purpose of the Study:
- To announce Medicare's national coverage decision for lung and heart-lung transplantations.
- To define the criteria for medically reasonable and necessary transplant services.
Main Methods:
- Review of medical evidence and expert consultation.
- Establishment of specific criteria for facilities and patient selection.
Main Results:
- Lung and heart-lung transplants are deemed medically reasonable and necessary under specific circumstances.
- Coverage is contingent upon Medicare-participating facilities meeting defined criteria.
Conclusions:
- Medicare coverage is established for lung and heart-lung transplants for eligible patients.
- The decision outlines conditions for coverage, including facility and patient criteria.
Abstract:
This notice announces a Medicare national coverage decision for lung and heart-lung transplantations. Lung transplantation refers to the transplantation of one or both lungs from a single cadaver donor. Heart-lung transplantation refers to the transplantation of one or both lungs and the heart from a single cadaver donor. We have determined that, under certain circumstances, lung transplants and heart-lung transplants are a medically reasonable and necessary service when furnished to patients with progressive end-stage pulmonary or cardiopulmonary disease and when furnished by Medicare participating facilities that meet specific criteria, including patient selection criteria. DATES: This notice is effective February 2, 1995. For information on how this notice effects Medicare payment for lung and heart-lung transplants, see sections E and F of this notice.