Standard Contracts
Covered Transplant Services Covered by the AgreementMedicaid Managed Care Agreement • June 4th, 2020
Transplant type Adult Pediatric Autologous bone marrow/stem cell (single) Tandem autologous bone marrow stem cell transplant (2 autologous transplants) Sequential autologous bone marrow stem cell transplants (3 or 4 autologous transplants) Allogeneic bone marrow/stem cell related Allogeneic bone marrow/stem cell unrelated Cord blood (single or multiple units) Tandem allogeneic first procedure (allo/allo) Tandem allogeneic (auto/allo/cord [single or multiple units]) (allo/allo/cord [single or multiple units]) Heart Lung (single) Lung (double) Heart lung Liver — deceased donor Liver — living donor Liver kidney Kidney — deceased donor Kidney — living donor Kidney — pancreas (SPK) Pancreas after Kidney (PAK) Pancreas (PTA)
MODEL CONTRACT October 1, 2005Medicaid Managed Care Agreement • November 4th, 2005 • Amerigroup Corp • Hospital & medical service plans • New York
