Coding and Billing Resources
Our team works with many payers across the health care landscape. We maintain a robust reimbursement support resource center for transplant centers that contains useful information about coding and billing. This information may be useful to payers to understand how transplant centers are advised to code and subsequently bill for services. We provide this information to both payers and providers because billing for HCT is different from solid organ transplant in many ways.
The categories of payer information we provide includes:
Medicare – Including information regarding Medicare Coverage and Authorization, Cancelled Transplants, Rate-Setting and Billing.
Medicaid – Including information regarding Medicaid Coverage and Authorization, as well as the Prior Authorization Form.
Commercial – Including a sample Letter of Medical Necessity, Prior Authorization Form, and the Coverage Determination Checklist.
American Indian and Native Alaskan Coverage – Including resources regarding Indian Health Services (IHS) coverage.
And finally, general resources including clinical trials, appeals process and FAQs.
- Use this code sheet (PDF) to help plan for the implementation of the new ICD-10-PCS Coding System. The new system will require drastically different—and much more detailed—documentation for coders to report complete and accurate procedure codes.
- View an updated ICD-10 diagnosis code crosswalk to help coders report correctly in the new system.
- Learn about the HLA typing standards, costs, and coding (PDF) for the development of policies concerning joining the national registry.
- View an overview of new cord blood transplant regulations with the Payer's Guide to FDA Cord Blood Regulations (PDF).
- Download the Standardized Transplant Authorization Form (PDF) for Transplant Centers and Payers.
- This new resource outlines the Affordable Care Act (ACA)'s provisions around clinical trials access and provides a link to an American Society of Clinical Oncology (ASCO) form (PDF) that transplant centers can use with payers who may have questions about trial eligibility.