TGH Transplant Program Supplier Application

Evaluation of Transplant Patient


Reimbursement for services will be made by Medicare's Organ Acquisition Account (OAA). The OAA account includes payment for services to determine an individual's candidacy for living organ donation. Claims are paid at 100% of Medicare fee schedule for Professional based claims and at facilities cost to charge ratio from your latest Medicare cost report for hospital-based claims. Tampa General Hospital administers this account. By acceptance of this authorization, you agree not to bill the patient, but direct such billing to Tampa General Hospital, Transplant Services.

Additional interpretative or professional services resulting from this evaluation testing will also be paid according to the Medicare fee schedule. Please inform your providers of this payment agreement. To receive payment from the OAA at Tampa General Hospital:

  • Please complete and attach the TGH Supplier Set Up Application (Click To Download) and W-9 Form (Click To Download) package listed on this site. This is for first time users only.
  • After completing, please upload requested information along with any claims for any pre-Transplant evaluations.
  • Provide all CPT procedure and ICD-10 diagnosis codes and charges for each service.
  • Identify provider name and payment mailing address.
  • Please allow at least 45 days for payment
  • Tampa General Hospital will pay 100% of the Medicare allowable fee schedule for Professional Billing services. Any Hospital Based billing will be paid using your hospital’s cost to charge ratio from your current Medicare cost report.

Any questions to this please contact John Rothenberger, Reimbursement Manager at

W-9 Form (Click To Download)

TGH Supplier Set Up Application (Click To Download)