Institute of Good Manufacturing Practices India®

Excluding organ acquisition charges from Inpatient Prospective Payment System (IPPS) payment calculation: MM11087

Suppliers and providers involved in submitting claims in Inpatient Prospective Payment System (IPPS) need to stay updated with the recent MM11087. There is a system change where medical coders need to confirm that organ acquisition cost will remain excluded from IPPS payment calculation.

There will be payment deduction for organ acquisition with revenue code 081X from the total charge before submitting inpatient Bill type claim to IPPS. It is done to limit the potential overpayment. This change is implemented since 01 July 2019.

Organ transplant payment contains two components. A PPS rate is paid to the approved transplant centers for organ transplant. Organ acquiring cost is also reimbursed to the approved transplant centers.

Currently, organ acquiring cost is considered as an adjustment while submitting IPPS payment.  0811 and 0812 are separate codes for organ acquisition charges. These are not constituted under organ transplant payment under IPPS.