Medicare Managed Care Manual (Pub. 100-16), Ch. 18b § 120
End Stage Renal Disease (ESRD)
120 - End Stage Renal Disease (ESRD)
(Rev. 30, 09-05-03)
Individuals who have been medically determined to have ESRD are not eligible to elect
to enroll in an HCPP. However, individuals already enrolled in the organization who
subsequently become eligible for Medicare because of ESRD, and aged Medicare
enrollees who subsequently develop ESRD, cannot be disenrolled from the organization
as a result of the development of ESRD. Special limitations apply to Medicare program
payment for ESRD services. For dialysis and related services, CMS carriers process
physician claims and CMS intermediaries process facility claims.
For a full discussion of ESRD reimbursement under Medicare, see Chapter 27 of the
Provider Reimbursement Manual (Pub. 15), Part I. In addition, general information on
coverage, entitlement, and billing for ESRD services under Medicare can be obtained
from either the Renal Dialysis Facility Manual or the Hospital Manual.