Corporate

June 2, 2015
Updated - June 8, 2015

Kidney Acquisition Services and HCPCS modifier Q3

When a living donor receives services in a hospital prior to a kidney donation, all hospital and physicians’ services costs applicable to the medical evaluation are considered kidney acquisition service costs and billed to Medicare Part A through the hospital.  These services should not be billed with modifier Q3.

When the live donor subsequently enters the hospital for the actual kidney donation, the hospital costs of services rendered to the donor will continue to be treated as kidney acquisition service costs under Part A. However, at that point, physician services are not.  Instead, during the donor’s inpatient stay for the excision surgery and during any subsequent donor inpatient stays resulting from a direct complication of the organ donation, physician services are billed under Part B.

Modifier Q3 should only be used for live kidney donor services and associated post op medical complications related to the kidney donation. Upon review, we have found Part A acquisition services submitted to CGS as Part B services with HCPCS modifier Q3 and improperly paid.  Refunds may be requested on services paid in error.

For information specific to recipient and donor charges for kidney transplant services, please refer to the CMS Internet Only Manual, 100-04, Chapter 3, Section 90.1.1External PDF and 100-02, Chapter 11, Section 140External PDF.


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