Equipment and Supplies

20.4 - Equipment and Supplies (Rev. 13599, Issued: 01-30-26, Effective: 05-01-26, Implementation: 05-01-26) All medically necessary equipment and supplies used to furnish dialysis (in-facility or in a patient’s home) are not separately paid as of January 1, 2011, and payments for these items were incorporated into the ESRD PPS base rate. These equipment and supplies include: • Equipment and supplies included under the composite rate (see §20.1 of this chapter) as of December 31, 2010, • Equipment and supplies that were formerly billed by ESRD facilities and paid separately by Medicare (i.e., supplies used to administer drugs and biological products), and • Equipment and supplies furnished to home patients that were under Method II* prior to January 1, 2011, and billed by Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers and paid separately by Medicare. * Prior to the ESRD PPS, under Method II, the beneficiary dealt directly with a DMEPOS supplier to secure home dialysis equipment and supplies (including supportive equipment). Beginning January 1, 2011, Method II is no longer an option for home dialysis items and services under Medicare. As a result, effective January 1, 2011, the ESRD facility assumes responsibility for furnishing all equipment and supplies for all its patients who dialyze in-facility and those who dialyze at home. ESRD facilities and MCP physicians and practitioners may order dressings or protective access coverings, including catheter coverings, for a patient to use on their dialysis access site. These dressings or protective access coverings used during or after dialysis to protect a dialysis patient’s access site including, for example, coverings used for day-to-day activities such as bathing, are considered to be renal dialysis services, and the ESRD facilities is responsible for providing them. Medicare payment for vascular access equipment and supplies is included in the ESRD PPS for all dialysis patients regardless of the method of dialysis or where they receive dialysis treatments. For more information on MCP physicians and practitioners, see Pub. 100-04, chapter 8, section 140. When dialysis access has been surgically placed in a patient to enable an ESRD facility to provide dialysis treatment, and the patient has started dialysis, the dressing changes are included in the ESRD PPS whether they are furnished in the facility or in the home by the ESRD facility. ESRD facilities may not receive payment for renal dialysis equipment and supplies from ESRD beneficiaries. A. Equipment and Supplies Used for Reasons Other Than for the Treatment of ESRD 1. ESRD Facilities Occasionally ESRD facilities furnish items and services that are not used for the treatment of ESRD, primarily drugs and biological products. When this occurs, ESRD facilities can bill separately by using the AY modifier for the appropriate HCPCS codes used for the administration-supply of the drug or biological product that is being used for reasons other than for the treatment of ESRD. Any equipment or supply billed using the AY modifier will not be considered an eligible ESRD outlier service. These supplies include: • A4657: Injection administration-supply charge (includes the cost of alcohol swab, syringe, and gloves) and • A4913: IV administration-supply charge (includes the cost of IV solution administration set, alcohol swab, syringe, and gloves). A4913 should only be used when an IV solution set is necessary for drugs or biological products given for reasons other than for the treatment of ESRD. 2. Other Providers and Suppliers There are renal dialysis equipment and supplies that may also be used in other provider settings for reasons other than for the treatment of ESRD. These equipment and supplies can be found in the document entitled “Items and Services Subject to Consolidated Billing for the ESRD PPS” located at the ESRD Payment website: http://www.cms.gov/Medicare/Medicare-Fee-for-Service- Payment/ESRDpayment/Consolidated_Billing.html. To allow DMEPOS suppliers to receive payment for furnishing these services to other provider types, the DMEPOS suppliers can bill the DME MAC for the supplies included on this list with the AY modifier, to indicate that the equipment is used for reasons other than for the treatment of ESRD. There are renal dialysis equipment and supplies that are not used in other provider settings. These equipment and supplies are also listed in the document entitled “Items and Services Subject to Consolidated Billing for the ESRD PPS.” These supplies and equipment are not otherwise covered by Medicare; therefore, DMEPOS suppliers are not able to bill any of the supplies on this list using the AY modifier.