Transplant Services definition

Transplant Services are Covered Services for solid organ transplants, autologous hemopoetic stem cell transplantation and allogeneic hemopoetic stem cell transplantation as described in the applicable Subscriber Agreement and Evidence of Coverage.

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Transplant Services means Covered Expenses incurred in connection with the Covered Transplants listed below that are for Medically Necessary Care and not considered to be an Experimental or Investigational measure. The following benefits will be payable for treatment or service for Transplant Services. These benefits will be payable instead of any other benefits described in this booklet, unless otherwise indicated below.

Transplant Services means Covered Expenses incurred in connection with the transplants listed below, which are Medically Necessary and not considered to be an Experimental or Investigational Measure. These benefits will be payable instead of any other benefits described in this booklet, unless otherwise indicated below.

Examples of Transplant Services in a sentence

• Transplant Services listed below are not Covered: • Non-human Organ transplants, except for porcine (pig) heart valve, are not Covered.

• Provider Manual: Interpreter Services Transplant Services N/A N/A HIV/AIDS Non-Medical Targeted Case Management for People Living with HIV/AIDS and those at High Risk for Acquiring HIV N/A Provider Manual: HIV/AIDS Providers AIDS Medical Case Management Includes client-specific advocacy and/or review of utilization of services.

• Services necessary to assess referral for formal evaluation for Transplant Services.

• Services necessary to assess referral for formal evaluation for Transplant Services and Medically Necessary inpatient and/or outpatient services, in order to maintain the Member’s health prior to transplant.

• Special Blue Shield requires prior authorization for all Special Transplant Services, and all services must be provided at a Special Transplant Facility designated by Blue Shield.

• Transplant Services Benefit covers skin, bone and corneal transplants.

• Medical Group shall be responsible for providing, coordinating and arranging Transplant Services for which it is financially responsible, subject to coordination with PacifiCare pursuant to the terms of PacifiCare’s MM Program.

• Specifically, but without limitation, authorization of the evaluation of the recipient prior to listing for transplantation, the actual transplant itself, and post transplant care up to 365 days post discharge, must be obtained from PacifiCare’s NPTN Medical Director, or his or her designee, prior to the provision of Transplant Services.

• Certain Human Organ and Tissue Transplant Services may be limited.

• Special 34 Note: Blue Shield requires prior authorization from Blue Shield's Medical ▇▇- ▇▇▇▇▇▇ for all Special Transplant Services.

More Definitions of Transplant Services

Transplant Services as used above includes charges for any transplant-related pre-operative office visits, the hospital’s facility fee, the surgical procedure (including, but not limited to, the surgeon’s fee, the assistant surgeon’s fee, the anesthesiologist’s fee, and charges for medical supplies), all transplant-related laboratory charges or x-rays, prescription drugs administered while the covered person was an inpatient during the transplant procedure, and any transplant-related post-operative office visits. Special Note: Any eligible service that is performed by an In-Network provider and billed with a place of service code “11” (physician’s office) or “20” (urgent care center) shall be paid at 100% and all applicable deductible amounts shall be waived. However, the co-payment applicable to the physician’s exam will still be assessed.

Transplant Services means Covered Charges incurred in connection with the Covered Transplants listed below that are necessary and required for treatment and not considered to be an Experimental or Investigational Measure. The following benefits will be payable for Treatment or Service for Transplant Services. These benefits will be payable instead of any other benefits described in this Plan, except as otherwise provided in this section.

Transplant Services. This is transplantation (including retransplants) of the human organs or tissue listed above, including all related post-surgical treatment, follow-up care and drugs and multiple transplants for a related cause. Transplant Services do not include other organ or tissue transplants or surgical implantation of mechanical devices functioning as a human organ, except surgical implantation of an FDA approved Ventricular Assist Device (VAD) or total artificial heart, functioning as a temporary bridge to heart transplantation. Not Covered:

Transplant Services include the following: heart transplants, lung transplants, heart-lung transplants, liver transplants, kidney transplants, autologous bone marrow transplants, allegoric bone marrow transplants and corneal transplants as set forth in HSD/MAD regulations, 8.325.5 NMAC, TRANSPLANT SERVICES, and 8.325.6 NMAC, EXPERIMENTAL OR INVESTIGATIONAL PROCEDURES, TECHNOLOGIES, OR NON-DRUG THERAPIES.