26-812 Division of Financial Responsibility Guidelines for Post-Transplant Services
Date: 06/30/26
Financial responsibility across the post-transplant period
Under the Division of Financial Responsibility (DOFR), risk for post-transplant services is determined by the rendering provider and the timeframe following discharge. The Medi-Cal Provider Operations Manual has been updated to clarify existing guidance related to post-transplant services and the application of DOFR. The summary below reflects how financial responsibility is applied.
DOFR overview
Post-discharge timeframe | Type of service | Rendering provider | Financial responsibility |
|---|---|---|---|
0–365 days | Transplant-related services Limited to care provided by the designated transplant team or transplant facility. | Transplant team or transplant facility | Health Net |
0–365 days | Non-transplant-related services Includes all services provided by any other provider, regardless of diagnosis. | All other providers1
| Participating physician group or |
More than 1 year post-discharge | All services After 1 year post-discharge, the special transplant categorization period ends, and all services fall under the respective category in accordance with the DOFR. | All providers2
| Participating physician group or |
1Providers not part of the transplant team or transplant facility.
2Includes transplant team and transplant facility providers.
Access the Medi-Cal Provider Operations Manual
For additional details on transplant-related services:
- Go to the Provider Library and select Medi-Cal.
- Select Provider Manual.
- Navigate to the Benefits section.
- Select Transplants.
Questions
For questions or additional clarification, please contact the Health Net Provider Services Center at 800-675-6110.
This information applies to Participating Physician Groups (PPGs) and Hospitals.
For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.