Injections Furnished to ESRD Beneficiaries

20.5.8 - Injections Furnished to ESRD Beneficiaries (Rev. 397, Issued: 12-16-04, Effective: 01-01-05, Implementation: 01-03-05) When an ESRD beneficiary is given a renal related injection outside the ESRD facility or provider- setting, it should be administered by the beneficiary’s monthly capitation payment (MCP) physician or his/her staff as “incident to” such physician’s services. There is no additional allowance for the physician or his staff, e.g., an office nurse. This is because payment for the administration of a renal-related injection to a dialysis patient is included in the physicians’ monthly capitation payment (MCP). The regulations governing Medicare payment for physicians’ ESRD services (42 CFR 405.542) require that all physicians’ outpatient ESRD-related services except declotting shunts be paid under the MCP. If a physician, other than the patient’s MCP physician, administers a renal-related injection, the other physician must look to the MCP physician for compensation for the services. Although an additional allowance for the administration of a renal-related injection to a dialysis patient may not be made, the patient’s MCP physician or a physician other than the MCP physician may submit claims and be paid for the drug itself as well as supplies, e.g., needles and syringes, used to administer the drug. EXAMPLE: Dr. Jones is Mr. White’s MCP physician. Dr. Jones is unable to furnish the regular EPO injections his patient needs three times a week. It is Dr. Jones’ responsibility to compensate the physician who administers the injections. The administering physician submits claims for the injectable and necessary supplies. In this case, the A/B MAC (B) makes a reasonable monthly allowance, e.g., $3 for the cost of supplies (i.e., syringes and needles).