(a) Initial living donor evaluations. When a recipient and donor elect to participate in a kidney paired exchange, the costs of the initial living donor evaluations are incurred by the originally intended recipient's transplant hospital, regardless of whether the living donor actually donates to their originally intended recipient, a kidney paired exchange recipient, or does not donate at all.
(b) Additional tests after a match. In a kidney paired exchange, regardless of whether an actual donation occurs, once the donor and recipient are matched, any additional tests requested by the recipient's transplant hospital and performed by the donor's transplant hospital, are billed to the recipient's transplant hospital as charges reduced to cost (using the donor's transplant hospital's cost to charge ratio) and included as acquisition costs on the recipient transplant hospital's Medicare cost report.
(c) Procurement and transport of a kidney. When a donor's transplant hospital procures and furnishes a kidney to a recipient's transplant hospital all of the following are applicable:
(1) All costs must be reasonable and necessary.
(2)
(i) The donor's transplant hospital bills the recipient's transplant hospital.
(ii) The donor's transplant hospital bills its charges reduced to cost, or bills its applicable kidney SAC for the reasonable costs associated with procuring, packaging, and transporting the kidney.
(3) The donor's transplant hospital records the costs described in paragraph (c)(2)(ii) of this section on its Medicare cost report as kidney acquisition costs and offsets any payments received from the recipient's transplant hospital against its kidney acquisition costs.
(4) The recipient's transplant hospital records as part of its kidney acquisition costs -
(i) The amounts billed by the donor's transplant hospital for the reasonable costs associated with procuring, packaging, and transporting the organ; and
(ii) Any additional testing performed and billed by the donor's transplant hospital.
(d) Donor's procurement occurs at recipient transplant hospital. In a kidney-paired exchange -
(1) When a donor's transplant hospital does not procure a kidney, but the donor travels to the recipient's transplant hospital for the organ procurement, the reasonable costs associated with the organ procurement are included on the Medicare cost report of the recipient's transplant hospital; and
(2) The travel expenses of the living donor are not allowable Medicare costs.