CMS Puts ESRD Home Dialysis Policy in Writing

CMS Puts ESRD Home Dialysis Policy in Writing

The Centers for Medicare & Medicaid Services (CMS) has added language to its billing guidelines for home dialysis (less than full month) to be consistent with its policy for partial-month, center-based dialysis services.

In the 2011 Medicare Physician Fee Schedule (MPFS) final rule, CMS changed the policy for home dialysis (less than full month) to require the Monthly Capitation Payment (MCP) practitioner to furnish at least one face-to-face patient visit per month as a condition of payment, but failed to update billing guidelines. Stakeholders brought this to the attention of CMS as part of the 2015 MPFS rulemaking cycle, and CMS finalized the change in the 2015 MPFS final rule.

CPB : Online Medical Billing Course

Effective January 1, 2015 MCP physicians and practitioners should bill for the age-appropriate home dialysis service, as described by CPT® codes 90963-90966, if the MCP physician or practitioner furnishes:

  • A complete monthly assessment of the end stage renal disease (ESRD) patient; and
  • At least one face-to-face patient visit during the month.

Medicare contractors have until September 8, 2015 to implement this change in billing guidelines, per CMS Change Request 9265.

See Pub. 100-04, Medicare Claims Processing, chapter 8, section 140.2.1 for more information about billing patients for home dialysis services under Medicare Part B.

Source: CMS MLN Matters® MM9265.

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Renee Dustman

Renee Dustman

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.
Renee Dustman

About Has 423 Posts

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.

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