Heart Transplants

Medicare covers heart transplants performed in facilities that are Medicare-approved and meet institutional criteria (CMS Ruling 87-1); pediatric transplants are covered only when a pediatric hospital has a CMS‑approved joint program with shared surgeons, QA, and specialized pediatric services. Follow-up care and immunosuppressive drugs are covered when reasonable and necessary per Medicare manuals, while VADs and artificial hearts are covered under separate NCD criteria (§20.9). Approvals are denied for programs under 2 years and for consortium applications, and multi-hospital programs are allowable only under strict shared-resources, documentation, and data-submission conditions.

"Cardiac transplantation is covered when performed in a facility that is Medicare-approved and meets the institutional coverage criteria in CMS Ruling 87-1."

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