CurrentBlue KCPolicy POL-PP-237

Organ Acquisition Costs

Governs payment and documentation requirements for organ acquisition costs submitted by certified transplant centers to Blue KC for commercial lines of business; applies to facility and professional providers as indicated.

Policy Summary

PayerBlue KC

PolicyOrgan Acquisition Costs

Policy CodePolicy POL-PP-237

Change TypeNo material changes

Effective DateJan 1, 2023

Next Review DateN/A

Key ActionSubmit CMS-2552-10 Worksheet D4, Parts I-IV upon request when a claim contains organ acquisition costs; failure to submit will result in claim denial as incomplete.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

CMS-2552-10Form requested to substantiate organ acquisition costs

DeniedClaims denied if worksheets not submitted

AllowedAllowed costs paid as substantiated

MultipleCommercial lines impacted

Initial 2023Revision history

Organ Acquisition Cost Coverage

Organ acquisition cost submission and payment criteria

Coverage stance and requirements for organ acquisition costs submitted by certified transplant centers:

When a certified transplant center submits a claim that includes organ acquisition costs, Blue KC will stop the claim and request Form CMS-2552-10, Worksheet D4, Parts I-IV to detail those costs.

Blue KC will pay the allowed organ acquisition costs as substantiated in the Cost Report (Form CMS-2552-10 Worksheet D4).

If a facility claim billed for organ acquisition costs does not provide Form CMS-2552-10 Worksheets I-IV upon request, the claim will be denied as an incomplete claim submission.

Coverage and final payment are subject to member eligibility, benefit limits, provider agreement terms, standard coding rules, and claims adjudication edits.

Policy Summary

PayerBlue KC

PolicyOrgan Acquisition Costs

Policy CodePolicy POL-PP-237

Change TypeNo material changes

Effective DateJan 1, 2023

Next Review DateN/A

Key ActionSubmit CMS-2552-10 Worksheet D4, Parts I-IV upon request when a claim contains organ acquisition costs; failure to submit will result in claim denial as incomplete.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Documentation & Submission Requirements

Documentation Required

Submit CMS-2552-10 Worksheet D4 (Parts I–IV) when requested

When a certified transplant center submits a claim that includes organ acquisition costs, Blue KC will stop the claim and request Form CMS-2552-10, Worksheet D4, Parts I–IV (Computation of Organ Acquisition Costs and Charges for Hospitals Which Are Certified Transplant Centers) to detail those costs. Failure to submit the requested worksheets will result in the claim being denied as an incomplete claim submission.

Submit CMS-2552-10, Worksheet D4, Parts I–IV upon request.
If the facility does not provide Worksheets I–IV when requested, the claim will be denied as an incomplete submission.
Blue KC will pay allowed organ acquisition costs as substantiated in the Cost Report (Worksheet D4).

OpenPayer

Organ Acquisition Costs

Organ Acquisition Cost Coverage

Relevant Codes

Documentation & Submission Requirements

Key Definitions