CHAPTER 33 - ORGAN PROCUREMENT ORGANIZATION AND TISSUE TYPING LABORATORY COST REPORT - FORM CMS-216-94

Sep 19, 2026

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Chapter 33 outlines reporting requirements for independent organ procurement organizations (OPOs) and independent histocompatibility laboratories, specifying that Form CMS-216-94 must be submitted for cost reporting periods ending on or after December 31, 1994. It explains when substitute forms may be used with advance approval, how to structure required worksheets and certification components, and which worksheets to bypass when limited to kidney procurement functions or to tissue-only typing tests. It also provides guidance for allocating overhead and handling acquired organ types, including offsetting certain tissue-related income against specified coordinator costs.

LanguageEnglish

CategoryForms

FormatPDF

Pages67

Reading Time23 min

AccessFree to download

General

Recommended Sequence for Completing OPO/LAB Cost Report

Worksheet S-Organ Procurement Organization/Histocompatibility Laboratory General Data and Certification Statement

Worksheet S-1-Organ Procurement Organization/Histocompatibility Laboratory Identification Data

Worksheet A-Reclassification and Adjustment of Trial Balance of Expenses

Worksheet B-Cost Allocation

Worksheet C-Computation of Medicare Cost

Worksheet D-Calculation of Reimbursement Settlement

Worksheet E-Balance Sheet

Supplemental Worksheet A-5-1-Statement of Costs of Services From Related Organizations

Kidney Placement Efforts - Documentation Requirements

Exhibit 1-Form CMS-216-94 Worksheets

Electronic Reporting Specifications for Form CMS-216-94

CHAPTER 33 ORGAN PROCUREMENT ORGANIZATION AND TISSUE TYPING LABORATORY COST REPORT FORM CMS-216-94 Section General .................................................................................................................3300 Recommended Sequence for Completing OPO/LAB Cost Report .....................3301 Worksheet S-Organ Procurement Organization/ Histocompatibility Laboratory General Data and Certification Statement .....................................................................................3302 Part I-General ...............................................................................................3302. 1 Part II-Certification By Officer or Administrator ........................................3302.2 Part III – Settlement Summary ......................................................................3302.3 Worksheet S-1-Organ Procurement Organization/ Histocompatibility Laboratory Identification Data ...........................................3303 Part I-OPO Statistics ....................................................................................3303. 1 Part II-Lab Statistics ....................................................................................3303.2 Part III-Full Time Equivalent Employees (FTEs) .......................................3303.3 Worksheet A-Reclassification and Adjustment of Trial Balance of Expenses .........................................................................................3304 Worksheet A-1-Administrative and General Expenses .....................................3305 Worksheet A-2-Organ Acquisition Costs ..........................................................3306 Worksheet A-3-Tissue Typing Laboratory Costs ..............................................3307 Worksheet A-4-Reclassifications.......................................................................3308 Worksheet A-5-Adjustments to Expenses .........................................................3309 Worksheet A-6-Capital Expenditures and Depreciation Reconciliation ...................................................................................................3310 Worksheet B-Cost Allocation-General Service Costs and Worksheet B-1-Cost Allocation-Statistical Basis ..................................................................................................................3311 Worksheet C-Computation of Medicare Cost....................................................3312 Worksheet D-Calculation of Reimbursement Settlement ..................................3313 Worksheet E-Balance Sheet...............................................................................3314 Worksheet E-1-Statement of Operating Expenses and Revenues ...........................................................................................................3315 Worksheet E-2-Statement of Revenues and Expenses ......................................3316 Supplemental Worksheet A-5-1-Statement of Costs of Services From Related Organizations ...............................................................3317 Kidney Placement Efforts-Documentation Requirements .................................3318 Exhibit 1-Form CMS-216-94 Worksheets .........................................................3390 Electronic Reporting Specifications for Form CMS-216-94 ............................ 3395 3300. GENERAL All independent organ procurement organizations (OPOs) and independent histocompatibility laboratories (Labs) must submit Form CMS-216-94 for cost reporting periods ending on or after December 31, 1994. Substitute forms may be used with advance approval from the intermediary and the Centers for Medicare and Medicaid Services (CMS) . Substitute forms must contain all information and data required by the standard form. Use Form CMS-216-94 unless advance approval is obtained. Form CMS-216-94 is used for the following cost reports: o Independent organ proc

FAQs

Who must submit Form CMS-216-94 for cost reporting?

All independent organ procurement organizations (OPOs) and independent histocompatibility laboratories must submit Form CMS-216-94 for cost reporting periods ending on or after December 31, 1994.

When can substitute forms be used instead of Form CMS-216-94?

Substitute forms may be used only with advance approval from the intermediary and CMS, and they must include all required information and data.

Which worksheets can be bypassed for kidney-only OPO activities or tissue-only lab typing?

If an OPO performs kidney procurement functions only with no other associated costs, bypass Worksheets B and B-1 and flow costs from Worksheet A to Worksheet C. If a lab performs only tissue typing tests with no organ procurement or other overhead-requiring activities, bypass Worksheets B and B-1 and flow costs directly from Worksheet A to the reimbursement calculation for tissue typing on Worksheet C.

Sep 19, 2026

Upload by Himbo