Medicare - Medical Management Programs
Bone Marrow and Organ Transplants
Bone marrow and organ transplants are covered when Medicare guidelines for medical necessity and the appropriateness of the patient are met.
All requests for organ transplants, except corneal transplants, require pre-authorization prior to any referral for patient appropriateness determination.
Pre-authorize bone marrow or organ transplant services with ConnectiCare as soon as the patient’s needs are known, prior to any evaluative services.
Services are available at Medicare approved transplant facilities. To obtain a listing of participating transplant facilities or to pre-authorize a transplant, call 1-800-508-6157.
What happens next?
• The case manager will request clinical documentation. Upon receipt, the case manager will review the documentation with ConnectiCare’s medical director to determine medical necessity and benefit coverage.
• The case manager or medical director may discuss the determination with you by phone and will follow up with a written determination.