Composite Rate Items and Services

20.1 - Composite Rate Items and Services (Rev. 13599, Issued: 01-30-26 , Effective: 05-01-26, Implementation: 05-01-26 ) Beginning January 1, 2011, all renal dialysis services (defined at §10.C of this chapter) are included in the ESRD PPS. Renal dialysis services include, but are not limited to, the items and services included under the composite rate as of December 31, 2010. Historically the composite payment rate (defined at §10.G.3 of this chapter) was the methodology for paying for dialysis services. The composite rate was a comprehensive payment for all modes of in-facility and home dialysis. On January 1, 2011, the composite rate was incorporated into the ESRD PPS payment methodology. Most items and services related to the treatment of the patient’s end-stage renal disease were covered under the composite rate payment, except physicians’ professional services, separately billable laboratory services, and separately billable drugs. If a facility, either directly or under an arrangement, failed to furnish any part of the items and services covered under the composite rate, then the ESRD facility could not be paid any amount for the service. This payment was subject to the normal Part B deductible and co-insurance requirements. Below are examples of items and services included under the composite rate and furnished, either directly or under arrangement, by the ESRD facility. • Dialysate; • Cardiac monitoring; • Catheter changes; • Suture removal; • Dressing changes; • Crash cart usage for cardiac arrest; • De-clotting of shunt performed by ESRD facility staff in the dialysis unit; • All oxygen and its administration furnished in the dialysis unit; • Staff time to administer blood; • Staff time to administer separately billable parenteral items; and • Staff time to collect specimens for laboratory tests.