Medicare Claims Processing Manual (Pub. 100-04), Ch. 8 § 140.1.2

Patients Who Switch Modalities (Center to Home and Vice

Last amended: 2010Year: 2010Length: 177 wordsOfficial source
140.1.2 - Patients Who Switch Modalities (Center to Home and Vice Versa) (Rev. 1999, Issued: 07-09-10, Effective: 01-01-11, Implementation: 01-03-11) If a home dialysis patient receives dialysis in a dialysis center or other outpatient facility during the month, the MCP physician or practitioner is paid the management fee for the home dialysis patient and cannot bill the ESRD-related services codes for managing center based patients. This situation should be coded using the ESRD–related services codes for a home dialysis patient per full month. Physicians and practitioners should use the ESRD–related services codes for a home dialysis patient per full month when billing for outpatient ESRD-related services when a home dialysis patient receives dialysis in a dialysis center or other outpatient facility during the month. Physicians and practitioners should use the ESRD–related services codes for a home dialysis patient per full month for patients that switch modalities regardless of whether the ESRD beneficiary went from home dialysis to center-based dialysis, or vice versa, and regardless of the proportion of the month that the beneficiary was receiving each modality.
Medicare Claims Processing Manual (Pub. 100-04), Ch. 8 § 140.1.2: Patients Who Switch Modalities (Center to Home and Vice | Justis AI