For services performed on or after October 1, 2004, Medicare will cover islet cell transplantation for patients with Type I diabetes who are participating in an NIH sponsored clinical trial. See Pub 100-04 (National Coverage Determinations Manual) section 260.3.1 for complete coverage policy.
The islet cell transplant may be done alone or in combination with a kidney transplant. Islet recipients will also need immunosuppressant therapy to prevent rejection of the transplanted islet cells. Routine follow-up care will be necessary for each trial patient. See Pub 100-04, section 310 for further guidance relative to routine care. All other uses for islet cell services will remain non-covered.
Healthcare Common Procedure Coding System (HCPCS) Codes
G0341: Percutaneous islet cell transplant, includes portal vein catheterization and infusion
Short Descriptor: Percutaneous islet cell trans
Type of Service: 2
G0342: Laparoscopy for islet cell transplant, includes portal vein catheterization and infusion
Short Descriptor: Laparoscopy islet cell trans
Type of Service: 2
G0343: Laparotomy for islet cell transplant, includes portal vein catheterization and infusion
Short Descriptor: Laparotomy islet cell transp
Type of Service: 2
Applicable Modifier for Islet Cell Transplant Claims for Carriers
Carriers shall instruct physicians to bill using the above procedure code(s) with modifier QR (Item or service provided in a Medicare-specified study) for all claims for islet cell transplantation and routine follow-up care related to this service.
Special Billing and Payment Requirements for Carriers
Payment and pricing information will be on the October 2004 update of the Medicare Physician Fee Schedule Database (MPFSDB). Pay for islet cell transplants on the basis of the MPFS. Deductible and coinsurance apply for fee-for-service beneficiaries.
