Medicare Claims Processing Manual (Pub. 100-04), Ch. 8 § 140.1.2
Patients Who Switch Modalities (Center to Home and Vice
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.