Transplant Business Best Practices: An American Society of Transplant Surgeons Business Practice Services Committee Opinion on Reimbursement, Cost Accounting, and Professional Coding in Modern Transplant Practice.

Financial stewardship in transplantation requires integrated management of three distinct reimbursement domains: organ acquisition, transplant hospitalization, and physician professional services. Of these, organ acquisition is often the most complex and least intuitively understood, despite its major financial implications. This article outlines business best practices for transplant programs. Organ Acquisition Cost Centers should be managed as cost recovery structures rather than profit centers, with attention to Medicare Cost Report mechanics, living donor cost reporting, organ statistics, and the apportionment ratio that determines Medicare's share of allowable acquisition cost. Commercial contracts should define pretransplant, transplant, posttransplant, and living donor services explicitly. The transplant hospitalization remains the principal source of hospital case margin under the Medical Severity-Diagnosis Related Group framework and therefore depends on documentation specificity, severity capture, complication management, and control of length of stay. Professional reimbursement requires standardized Current Procedural Terminology coding, modifier use, and clear understanding of the global surgical package. Together, these principles provide a practical framework for financially sustainable transplant practice.