Home Dialysis Items and Services

30.1 - Home Dialysis Items and Services (Rev. 13599, Issued: 01-30-26 , Effective: 05-01-26, Implementation: 05-01-26 ) Effective January 1, 2011, payment for renal dialysis services furnished for home dialysis are covered under the ESRD PPS and are not separately paid. ESRD facilities shall not bill Medicare beneficiaries directly when they furnish renal dialysis items and services included under the ESRD PPS. The ESRD facility receives the same bundled payment for home patients as it would receive for an in-facility patient under the ESRD PPS. Note: this includes all renal dialysis services furnished by the ESRD facility’s staff. The ESRD facility is responsible for the overall management of the home dialysis patient, including assuring that the patient is provided with equipment and supplies that are functional. This means the ESRD facility is responsible for delivering, installing, monitoring and maintaining supplies and equipment necessary to furnish all modalities of home dialysis either directly or under arrangement. For additional information regarding ESRD facility conditions for coverage for home dialysis services, refer to 42 CFR Part 494. A. Home Dialysis Equipment and Supplies All medically necessary equipment (including supportive equipment), supplies, and other items for home dialysis ordered by an MCP physician or practitioner that were included in the composite rate, are included under the ESRD PPS, and payments for these items were incorporated into the base rate. The MCP physician’s or practitioner’s order determines that an equipment or supply is furnished for the treatment of ESRD and therefore the responsibility of the ESRD facility. The order also provides documentation for CMS to use in determining if the equipment or supply is reasonable and necessary. The ESRD facility with which the patient is associated assumes responsibility for furnishing all home dialysis equipment, supplies, and support services either directly or under arrangements to all of its home dialysis patients. 1. Home Dialysis Equipment Furnished to Home Hemodialysis and Peritoneal Dialysis Patients Can Include: • All reasonable and necessary expenses incurred in the original installation of home dialysis equipment. Medicare does not pay for expenses attributable to home improvement (e.g., plumbing or electrical work), and there is no separate payment under the ESRD PPS for installation expenses even when covered. ESRD facilities are responsible for testing and assurance of equipment performance as specified in the ESRD Facility Conditions for Coverage in 42 CFR Part 494. • Supportive equipment that is used in conjunction with the basic dialysate delivery system, including blood pumps, heparin pumps, air bubble detectors, blood leak detectors, and unipuncture devices. • Adjustable chairs, such as recliners, as these chairs serve to preserve patients’ health by allowing rapid manipulation of body position when medical circumstances warrant such changes during dialysis (e.g., when acute hypotension occurs and the patient is in danger of going into shock). • Nonmedical items are also included in the ESRD PPS base rate and may not be billed separately. For example, if a home patient is wheelchair bound and it is medically necessary for the patient to weigh themselves before and after a dialysis treatment, the ESRD facility is responsible for furnishing the patient with a wheelchair scale. 2. Home Dialysis Supplies Furnished to Home Hemodialysis and Peritoneal Dialysis Patients ESRD facilities are responsible for supplies reasonable and necessary for the effective performance of all modalities of home dialysis, for example, alcohol wipes, sterile drapes, gloves, telfa pads, bandages, etc. Reasonable and necessary supplies may also include but are not limited to: start-up durable supplies (whether or not they are part of a start-up kit) such as weight scales, sphygmomanometer, I.V. stand, and dialysate heaters; and consumable and disposable supplies, such as dialysate, tubing, and gauze pads. Instruments and nonmedical supplies, such as scales, stopwatches, and blood pressure apparatus are included in the ESRD PPS. C. Home Dialysis Hemodialysis and Peritoneal Dialysis Support Services Home dialysis support services identified at 42 CFR §§ 410.52 and 494.100 may be furnished in the home or in the ESRD facility. Support services include (but are not limited to): 1. Periodic monitoring of the patient’s home adaptation, including visits to the patient’s home by facility personnel in accordance with the patient’s plans of care; 2. Emergency visits to the home by qualified ESRD facility personnel; 3. Services provided by a qualified social worker and a qualified dietitian, made in accordance with a plan prepared and periodically reviewed by a professional team which includes the physician; 4. Individual’s unscheduled visits to an ESRD facility made on an as-needed basis; e.g., assistance with difficult access situations; 5. Renal dialysis laboratory tests covered under the ESRD PPS; 6. Providing, installing, repairing, testing, and maintaining home dialysis equipment, including appropriate water testing and treatment; 7. Ordering and delivering renal dialysis supplies on an ongoing basis; 8. Maintaining and submitting all required documentation to the ESRD network; 9. A complete medical record keeping system that ensures continuity of care; 10. Changing essential tubing; 11. Watching the patient perform dialysis to assure that it is done correctly and to review any aspects of the technique that may require modification; and 12. Inspecting the access site and documenting any access site infections that may require a physician intervention or hospitalization. The full range of home dialysis support services required by home patients are included in the ESRD PPS. Home dialysis support services must be furnished periodically. These services will usually be furnished during a periodic follow-up visit, but they may be furnished at separate times. They may be furnished in the ESRD facility or in the home. NOTE: For additional information on renal dialysis services furnished on or after January 1, 2011, and paid under the ESRD PPS, refer to §20 of this chapter. B. In-facility Dialysis Sessions Furnished to Home Patients Who Are Traveling Patients who are normally home dialysis patients may be dialyzed by a Medicare certified ESRD facility on an in-facility basis when traveling away from home. Patients who normally dialyze in an ESRD facility may wish to dialyze temporarily in another facility or as home dialysis patients while they travel or vacation. See Medicare Claims Processing Manual, Chapter 8, “Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims,” §100, for billing services when traveling. C. Staff Assisted Home Dialysis Staff-assisted home dialysis may include ESRD facilities sending staff to assist with home dialysis, but such services may not be billed to Medicare separately, because the cost of all ESRD facility staff time is included in the base rate.