Guest guest Posted January 6, 2005 Report Share Posted January 6, 2005 for medicare to pay for panc after kidney transplant, does the surgery have to occur within the 3 years after kidney transplant? I was under the impression that when you get your pancreas transplant, medicare transplant benefits start over and you have another 3 years? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2005 Report Share Posted January 6, 2005 for medicare to pay for panc after kidney transplant, does the surgeryhave to occur within the 3 years after kidney transplant? I was underthe impression that when you get your pancreas transplant, medicaretransplant benefits start over and you have another 3 years?[Aguiar, (Surgery)] A common misconception, but not true. Pancreas tx, unlike kidney, is NOT an entitlement event w/Medicare. A PAK is certainly a Medicare approved procedure (regardless of how long it's been since the kidney tx, btw, though if it's been many years since the kidney, your billers might have to submit copies of the kidney tx op report in order to document the prior history of renal disease {we just went thru this w/2 PAK's, actually}), BUT having a PAK will NOT get the recipient automatic Medicare coverage. He/she must be entitled to Medicare either thru ESRD, age, or disability nor does the PAK extend the ESRD coverage, btw-remember, only resumption of dialysis is grounds for extending coverage beyond the 36 months post kidney tx. Think of a PAK in the same context as a heart, lung, or liver tx, if that's easier-no one gets Medicare coverage automatically just because he/she has a heart, lung, or liver tx, right? Same for PAK. J. Aguiar Beth Israel Deaconess, Boston Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2005 Report Share Posted January 6, 2005 thanks laura. you explained it well >>> LAguiar@... 1/6/2005 9:31:40 AM >>> for medicare to pay for panc after kidney transplant, does the surgery have to occur within the 3 years after kidney transplant? I was under the impression that when you get your pancreas transplant, medicare transplant benefits start over and you have another 3 years? [Aguiar, (Surgery)] A common misconception, but not true. Pancreas tx, unlike kidney, is NOT an entitlement event w/Medicare. A PAK is certainly a Medicare approved procedure (regardless of how long it's been since the kidney tx, btw, though if it's been many years since the kidney, your billers might have to submit copies of the kidney tx op report in order to document the prior history of renal disease {we just went thru this w/2 PAK's, actually}), BUT having a PAK will NOT get the recipient automatic Medicare coverage. He/she must be entitled to Medicare either thru ESRD, age, or disability nor does the PAK extend the ESRD coverage, btw-remember, only resumption of dialysis is grounds for extending coverage beyond the 36 months post kidney tx. Think of a PAK in the same context as a heart, lung, or liver tx, if that's easier-no one gets Medicare coverage automatically just because he/she has a heart, lung, or liver tx, right? Same for PAK. J. Aguiar Beth Israel Deaconess, Boston Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2005 Report Share Posted January 6, 2005 Hi Patti, I believe they do have to get the surgery within the 36 month period, and I do not believe the benefits start over. Does anyone else have a different understanding? Betsy panc after kidney for medicare to pay for panc after kidney transplant, does the surgery have to occur within the 3 years after kidney transplant? I was under the impression that when you get your pancreas transplant, medicare transplant benefits start over and you have another 3 years? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2005 Report Share Posted January 6, 2005 Just to clarify, PAK Medicare will pay for the immunosuppressive drugs for 36 months after the month of the pancreas transplant. -----Original Message-----From: LAguiar@... Sent: Thursday, January 06, 2005 9:32 AMTo: TxFinancialCoordinators Subject: RE: panc after kidney for medicare to pay for panc after kidney transplant, does the surgeryhave to occur within the 3 years after kidney transplant? I was underthe impression that when you get your pancreas transplant, medicaretransplant benefits start over and you have another 3 years?[Aguiar, (Surgery)] A common misconception, but not true. Pancreas tx, unlike kidney, is NOT an entitlement event w/Medicare. A PAK is certainly a Medicare approved procedure (regardless of how long it's been since the kidney tx, btw, though if it's been many years since the kidney, your billers might have to submit copies of the kidney tx op report in order to document the prior history of renal disease {we just went thru this w/2 PAK's, actually}), BUT having a PAK will NOT get the recipient automatic Medicare coverage. He/she must be entitled to Medicare either thru ESRD, age, or disability nor does the PAK extend the ESRD coverage, btw-remember, only resumption of dialysis is grounds for extending coverage beyond the 36 months post kidney tx. Think of a PAK in the same context as a heart, lung, or liver tx, if that's easier-no one gets Medicare coverage automatically just because he/she has a heart, lung, or liver tx, right? Same for PAK. J. Aguiar Beth Israel Deaconess, Boston Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2005 Report Share Posted January 6, 2005 just so i am not confused. . . . say for example 3 1/2 years after a kidney transplant a patient gets a panc. Though the patient doesn't have medicare any longer, his panc surgery/hospitalzation is covered by ESRD medicare. Immunos are covered under their ESRD medicare for three years after panc????so they reinstate their medicare B at time of panc transplant??? >>> Diane.Babbitt@... 1/6/2005 10:54:22 AM >>> Just to clarify, PAK Medicare will pay for the immunosuppressive drugs for 36 months after the month of the pancreas transplant. RE: panc after kidney for medicare to pay for panc after kidney transplant, does the surgery have to occur within the 3 years after kidney transplant? I was under the impression that when you get your pancreas transplant, medicare transplant benefits start over and you have another 3 years? [Aguiar, (Surgery)] A common misconception, but not true. Pancreas tx, unlike kidney, is NOT an entitlement event w/Medicare. A PAK is certainly a Medicare approved procedure (regardless of how long it's been since the kidney tx, btw, though if it's been many years since the kidney, your billers might have to submit copies of the kidney tx op report in order to document the prior history of renal disease {we just went thru this w/2 PAK's, actually}), BUT having a PAK will NOT get the recipient automatic Medicare coverage. He/she must be entitled to Medicare either thru ESRD, age, or disability nor does the PAK extend the ESRD coverage, btw-remember, only resumption of dialysis is grounds for extending coverage beyond the 36 months post kidney tx. Think of a PAK in the same context as a heart, lung, or liver tx, if that's easier-no one gets Medicare coverage automatically just because he/she has a heart, lung, or liver tx, right? Same for PAK. J. Aguiar Beth Israel Deaconess, Boston _____ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2005 Report Share Posted January 6, 2005 Having a PAK transplant does not re-qualify the patient for Medicare coverage or immunosuppressive drug coverage. Patients only have immunosuppressive drug coverage during the times that they actually HAVE entitlement to Medicare. So your patient would have to have Medicare based upon Age or Disability to have Rx coverage post-PAK. Fred L. Forsthoffer, MBA Financial Analyst Banner Good Samaritan Transplant Services , , F- RE: panc after kidney for medicare to pay for panc after kidney transplant, does the surgery have to occur within the 3 years after kidney transplant? I was under the impression that when you get your pancreas transplant, medicare transplant benefits start over and you have another 3 years? [Aguiar, (Surgery)] A common misconception, but not true. Pancreas tx, unlike kidney, is NOT an entitlement event w/Medicare. A PAK is certainly a Medicare approved procedure (regardless of how long it's been since the kidney tx, btw, though if it's been many years since the kidney, your billers might have to submit copies of the kidney tx op report in order to document the prior history of renal disease {we just went thru this w/2 PAK's, actually}), BUT having a PAK will NOT get the recipient automatic Medicare coverage. He/she must be entitled to Medicare either thru ESRD, age, or disability nor does the PAK extend the ESRD coverage, btw-remember, only resumption of dialysis is grounds for extending coverage beyond the 36 months post kidney tx. Think of a PAK in the same context as a heart, lung, or liver tx, if that's easier-no one gets Medicare coverage automatically just because he/she has a heart, lung, or liver tx, right? Same for PAK. J. Aguiar Beth Israel Deaconess, Boston _____ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2005 Report Share Posted January 6, 2005 It was my understanding that Medicare will pay as long as it is done after a kidney txp or simultaneously. There was no time period put on it. >>> PMontemayor@... 01/06/05 10:24AM >>> for medicare to pay for panc after kidney transplant, does the surgery have to occur within the 3 years after kidney transplant? I was under the impression that when you get your pancreas transplant, medicare transplant benefits start over and you have another 3 years? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2005 Report Share Posted January 6, 2005 I believe as of October 1st Medicare will also pay for pancreas-only transplants (no prior kidney Tx). Medicare pays only if the patient has Medicare at the time of the PAK transplant. There have never been any time limits with PAK Tx. Fred L. Forsthoffer, MBA Financial Analyst Banner Good Samaritan Transplant Services , , F- Re: panc after kidney It was my understanding that Medicare will pay as long as it is done after a kidney txp or simultaneously. There was no time period put on it. >>> PMontemayor@... 01/06/05 10:24AM >>> for medicare to pay for panc after kidney transplant, does the surgery have to occur within the 3 years after kidney transplant? I was under the impression that when you get your pancreas transplant, medicare transplant benefits start over and you have another 3 years? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2005 Report Share Posted January 7, 2005 I agree, No medicare time period limit. Bogan-Hightower Transplant Financial Coordinator Harper University Hospital 313 745-6128 313745-6083-fax Re: panc after kidney It was my understanding that Medicare will pay as long as it is done after a kidney txp or simultaneously. There was no time period put on it. >>> PMontemayor@... 01/06/05 10:24AM >>> for medicare to pay for panc after kidney transplant, does the surgery have to occur within the 3 years after kidney transplant? I was under the impression that when you get your pancreas transplant, medicare transplant benefits start over and you have another 3 years? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2005 Report Share Posted January 7, 2005 Can you give us more info on this? Or refer to where this rule might be located? Thanks, Joan Re: panc after kidney It was my understanding that Medicare will pay as long as it is done after a kidney txp or simultaneously. There was no time period put on it. >>> PMontemayor@... 01/06/05 10:24AM >>> for medicare to pay for panc after kidney transplant, does the surgery have to occur within the 3 years after kidney transplant? I was under the impression that when you get your pancreas transplant, medicare transplant benefits start over and you have another 3 years? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2005 Report Share Posted January 7, 2005 In looking for references, it turns out that Section 773 of the Medicare Prescription Drug Improvement and Modernization Act of 2003 mandates CMS to cover pancreatic Islet Cell transplants as of 10/04/04, but only in the context of an NIH-sponsored clinical trial. Sec. 1/260.3.1 of the NCD Manual Fred L. Forsthoffer, MBA Financial Analyst Banner Good Samaritan Transplant Services , , F- Re: panc after kidney It was my understanding that Medicare will pay as long as it is done after a kidney txp or simultaneously. There was no time period put on it. >>> PMontemayor@... 01/06/05 10:24AM >>> for medicare to pay for panc after kidney transplant, does the surgery have to occur within the 3 years after kidney transplant? I was under the impression that when you get your pancreas transplant, medicare transplant benefits start over and you have another 3 years? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 10, 2005 Report Share Posted January 10, 2005 Thanks, that does mean progress toward coverage. Joan Re: panc after kidney It was my understanding that Medicare will pay as long as it is done after a kidney txp or simultaneously. There was no time period put on it. >>> PMontemayor@... 01/06/05 10:24AM >>> for medicare to pay for panc after kidney transplant, does the surgery have to occur within the 3 years after kidney transplant? I was under the impression that when you get your pancreas transplant, medicare transplant benefits start over and you have another 3 years? Quote Link to comment Share on other sites More sharing options...
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