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Organ Donor Services

I. Medical Coverage

  1. Most HMSA plans cover organ donor services if the recipient is an HMSA member and the transplant has been approved by HMSA.
  2. If the donor is also covered by an HMSA plan, the donor’s plan will not pay for donor-related services.
  3. Benefits for the screening of donors under the recipient’s HMSA plan include payment of those expenses associated with the actual donor. Expenses associated with the screening of other donor candidates are not a benefit.

II. Claims Filing Information

Circumstance Where to file the claim
Both the recipient and donor are covered by their own HMSA plan. File the claim under the recipient’s HMSA plan. Benefits will not be paid by the donor’s plan.
The recipient is covered by an HMSA plan while the donor is covered by another medical benefit plan. File the claim under the recipient’s HMSA plan.
The recipient is covered by an HMSA plan while the donor is anonymous or does not have health insurance. File the claim under the recipient’s HMSA plan. In Block 19 of the CMS 1500 claim form, or in the “comments” field for electronic claims, identify the donor, and indicate the “donor does not have health insurance” or, if the donor is anonymous write “anonymous”.
The recipient is covered by a medical benefit plan other than HMSA, while the donor is covered by an HMSA plan. File a claim under the recipient’s health plan. Do not file a claim with the donor’s HMSA plan, since the claim would be denied.

Completing the claim form for organ donor services billed to the recipient’s HMSA plan

  1. The recipient’s HMSA member ID number should appear in Block 1A of the CMS 1500 claim form.
  2. The recipient’s name should appear in Blocks 2 and 4.
  3. The donor’s name and the word “donor” should appear in Block 19. If the donor is anonymous, write “anonymous”.

Note: Plan 6 (coverage code 006) limits benefits for organ donor services to kidney and cornea donors only.

CURRENT AS OF 08/03/2026

Revision History

Date Nature of Revision
08/03/2026

Migrated to new platform.