PM 20-27-03: Payment

WAG 20-27-03.

HFS pays the hospital an all-inclusive rate for the admission. The transplant rate is limited to a maximum of 60% of the hospital's usual and customary charges. HFS pays for 3 days of pre-operative inpatient work-up. HFS also pays for a certain number of consecutive days, depending on the type of transplant:

  • 30 days for heart, heart/lung, lung (single or double), pancreas, or kidney/pancreas;
  • 40 days for liver; or
  • 50 days for bone marrow.

HFS pays for any medically necessary care before and after the days for each type of transplant at the usual rate for the hospital.