*Purpose: Medicare organ acquisition reimbursement (MOAR) from the Medicare Cost Report (MCR) includes but is not limited to costs associated with candidate evaluation, maintenance on the list, deceased and living kidney donation and costs of pre-transplant staff. MOAR is a fully loaded, cost-based reimbursement which can be as much as 80% of total reimbursement for kidney transplantation. We performed this study to compare the MOAR among adult kidney transplant programs categorized by annual transplant volume to quantify the financial impact and critical high dollar areas of MOAR.

*Methods: We calculated the total MOAR for kidney transplant reported in the MCR by all certified transplant centers using the 2018 Healthcare Cost Report Information System database. The reported Medicare reimbursement includes the costs of organ acquisition for Medicare transplants. We categorized kidney transplant programs in quartiles by transplant volume. We identified high dollar categories of MOAR. The kidney transplant diagnosis related group (DRG) payments were calculated from the federal fiscal year 2018 final rule correction notice DRG rates, DRG 652 weight for kidney transplant and facility specific prospective payment information.

*Results: Table 1 shows the average MOAR per program for each quartile. Table 2 shows the national average of Medicare reimbursement for kidney transplant with MOAR ranging from 77% to 87% of the total kidney transplant reimbursement. The MOAR shows a decreasing trend per Medicare transplant ($167,992 to $94,239) as transplant programs grow from less than 40 to greater than 150 transplants per program which can be attributed to economies of scale. Conversely, the average Medicare DRG payment per transplant increases slightly from $24,156 to $28,085 as transplant programs grow from less than 40 to greater than 150 transplants per program which can be attributed to larger programs located in higher wage locales with large teaching programs.

*Conclusions: MOAR through the MCR provides a significant revenue stream for transplant programs. It is critical that transplant centers closely manage MOAR to capture all allowable costs to insure appropriate reimbursement at year end.

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