Reserved

130 - Reserved (Rev. 171, Issued: 06-07-13, Effective: 01-01-11, Implementation: 09-09-13) Appendix A (Rev. 171, Issued: 06-07-13, Effective: 01-01-11, Implementation: 09-09-13) Composite Rate Tests for Hemodialysis, IPD, CCPD, and Hemofiltration (Items in bold are non composite rate test) Chemistry CPT Code Monthly Weekly 13 x Quarter Albumin 82040 X Alkaline Phosphates 84075 X ALT (SGPT) 84460 AST (SGOT) 84450 X Bilirubin, total 82247 Bilirubin, direct 82248 Calcium 82310 X Calcium ionized (billed with modifier CD or CE) 82330 X Calcium ionized (billed with modifier CF) 82330 X Chloride 82435 X Cholesterol 82465 CK, CPK 82550 CO2 (bicarbonate) 82374 X Creatinine 82565 X GGT 82977 Glucose 82947 LDH 83615 X Phosphorus 84100 X Potassium 84132 X Protein, total 84155 X Sodium 84295 Triglycerides 84478 Urea nitrogen (BUN) 84520 X Uric Acid 84550 Appendix B (Rev. 171, Issued: 06-07-13, Effective: 01-01-11, Implementation: 09-09-13) Composite Rate Tests for CAPD (Items in bold are non composite rate test) Chemistry CPT Code Monthly Weekly 13 x Quarter Albumin 82040 X Alkaline Phosphatase 84075 X ALT (SGPT) 84460 AST (SGOT) 84450 X Bilirubin, total 82247 Bilirubin, direct 82248 Calcium 82310 X Calcium ionized (billed with modifier CD or CE) 82330 X Calcium ionized (billed with modifier CF) 82330 X Chloride 82435 Cholesterol 82465 CK, CPK 82550 CO2 (bicarbonate) 82374 X Creatinine 82565 X GGT 82977 Glucose 82947 LDH 83615 X Phosphorus 84100 X Potassium 84132 X Protein, total 84155 X Sodium 84295 X Triglycerides 84478 Urea nitrogen (BUN) 84520 X Uric Acid 84550 Appendix C (Rev. 171, Issued: 06-07-13, Effective: 01-01-11, Implementation: 09-09-13) Brief History of ESRD Composite Payment Rates for Outpatient Maintenance Dialysis Effective January 1, 2005, section 623 of the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) amended section 1881(b)(7) of the Act to require a 1.6 percent increase to the ESRD composite payment rate. The MMA also required a drug add-on adjustment to the composite payment rate to account for the difference between pre-MMA payments for separately billable drugs and payments based on revised drug pricing for 2005 which used average acquisition costs. For CY 2005, CMS computed a drug add-on adjustment of 8.7 percent. Effective January 1, 2006, section 5106 of the Deficit Reduction Act of 2005 amended section 1881(b)(12) of the Act to require a 1.6 percent increase to the ESRD composite payment rate. In addition, because the drug add-on adjustment is determined as a percentage of the composite payment rate, CMS must adjust the drug add-on adjustment to account for the 1.6 percent increase to the composite payment rate in order to ensure that the total dollars allocated from the drug add-on adjustment remains constant. The growth update to the drug add-on adjustment of 1.4 percent was unchanged; therefore the total drug add-on adjustment to the composite payment rate for 2006 was 14.5 percent. For dialysis services furnished on or after January 1, 2007 through March 31, 2007, the growth update to the drug add-on adjustment to the composite payment rate was 0.5 percent. As a result, the drug add-on adjustment to the composite payment rate for 2007 increased from 14.5 percent to 15.1 percent. For dialysis services furnished on or after April 1, 2007, section 103 of the Tax Relief and Health Care Act of 2006 amended section 1881(b)(12) of the Act to require a 1.6 percent increase to the ESRD composite payment rate. The effect of the 1.6 percent increase to the composite payment rate was a reduction in the drug add-on adjustment from 15.1 percent to 14.9 percent. Effective January 1, 2008, there was no increase to the composite payment rate however; the drug add-on adjustment to the composite payment rate was increased by a growth update of 0.5 percent. As a result, the drug add-on adjustment to the composite payment rate for CY 2008 increased from 14.9 percent to 15.5 percent. Effective January 1, 2009, section 153 of the Medicare Improvements for Patients and Providers Act of 2008 amended section 1881(b)(12) of the Social Security Act to require a 1 percent increase to the ESRD composite payment rate and that hospital-based ESRD facilities are paid the same composite payment rate as independent ESRD facilities. The effect of the 1 percent increase in the composite payment rate is a reduction in the drug add-on adjustment from 15.5 percent to 15.2 percent. Effective January 1, 2010, CMS continued to apply the growth update to the drug add-on adjustment to the composite payment rate, which was 0.percent. As a result, the drug add-on adjustment to the composite payment rate for 2010 was reduced from 15.2 to 15.0 percent. Also, as required by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), CMS applied a 1.0 increase to the ESRD composite payment rate. Section 153 of the MIPPA amended section 1881(b)(12) of the Social Security Act to require a 4-year transition (phase-in) from the current composite payment system to the ESRD Prospective Payment System (PPS). Effective January 1, 2011, CMS continued to apply the growth update to the drug add-on adjustment to the composite payment rate portion of the blended payment rate, which was 0.percent. As a result, the drug add-on adjustment to the composite payment rate portion of the blended payment for 2010 is reduced from 15.0 to 14.7 percent. For a detailed description of the transition period, see §70 of this chapter. For further information on the drug add on amounts for CY 2012 and 2013, see the respective ESRD final rules. Effective 2014, the drug add-on will no longer be applied. Future updates will be issued via Recurring Update Notifications.