ESRD PPS Quarterly Update Corrects Code Lists

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  • July 29, 2011
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A quarterly update to the End Stage Renal Disease Prospective Payment System (ESRD PPS) includes a couple of corrections that will require suppliers of durable medical equipment (DME) to check their claims for overpayments. Several DME supply codes have been removed from the consolidated billing edits list and added to the list of codes not payable to DME suppliers.

The Centers for Medicare & Medicaid Services (CMS) issued Transmittal 2134, Change Request (CR) 7064 on Jan. 14, 2011 to implement the new bundled payment system for renal dialysis items and services provided on or after Jan. 1, 2011. The CR included a list of equipment and supplies that are ESRD-related but can be used (with modifier AY Not ESRD-related) in other provider settings for reasons other than ESRD treatment. Attachment 5 of CR 7064 included the list of DME ESRD supply codes not separately payable.
On July 15, CMS issued Transmittal 2255, CR 7476 to correct attachments 4 and 5 of CR 7046. CR 7476 removes certain HCPCS Level II codes from attachment 4 and adds them to attachment 5, rendering the codes either not separately payable or not payable by Medicare. CMS also added surgical dressing code A6204 to attachment 5. The revised lists are retroactively effective Jan. 1, 2011, and are included in CR 7476.
CR 7476 also adds to the list of eligible codes for ESRD PPS comorbidity payment adjustment five new ICD-9-CM codes for the chronic comorbid condition under the hereditary hemolytic sickle cell anemia category (282.43-282.47). These new codes will go into effect Oct. 1.
Note: CMS will host an Open Door Forum Aug. 4 on the Notice of Proposed Rulemaking (NPRM) for the ESRD Quality Incentive Program (QIP), published in the July 8 Federal Register. The forum will include an overview of the proposed changes to the ESRD QIP for payment years 2013/14. For details and to register, visit

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    In terms of ESRD, is there a specific coverage policy relating to INTRADYALITIC PARENTERAL NUTRITION?