Medicare Claims Processing Manual (Pub. 100-04), Ch. 8 § 50.8
Training and Retraining
50.8 - Training and Retraining
(Rev. 12979; Issued: 11-22-24; Effective: 01-01-25; Implementation: 01-06-25)
See Pub. 100-02 Medicare Benefit Policy Manual, Chapter 11, for coverage rules for
dialysis training.
Training services and supplies that are covered under the Prospective Payment System
(PPS) base rate includes personnel services, dialysis supplies and parenteral items used in
dialysis, written training manuals, material and laboratory tests.
End Stage Renal Disease Prospective Payment System (ESRD PPS) claims with dates of
service on or after January 1, 2011, and Acute Kidney Injury (AKI) claims with dates of
service on or after January 1, 2025, billing for dialysis training sessions will receive a
home dialysis training add-on payment.
The home dialysis training add-on payment is adjusted by the ESRD PPS wage index and
added to the PPS base rate. The home dialysis training add-on payment accounts for
nursing time for training treatments. The home dialysis training add-on payment applies
to both peritoneal dialysis (PD) and hemodialysis (HD) training treatments. Updates to
the home dialysis training add-on payment are published through rulemaking.
Hemodialysis (HD) Training (082X):
An ESRD facility may bill a maximum of 25 training sessions per patient for
hemodialysis training.
Intermittent Peritoneal Dialysis (IPD) Training (083X):
An ESRD facility is not reimbursed for more three IPD treatments in a single week, for a
total duration longer than 3 months.
Continuous Ambulatory Peritoneal Dialysis (CAPD) Training (84X):
An ESRD facility may bill a maximum of 15 training sessions per patient for CAPD
training. The A/B MAC (A) will make a determination whether or not to permit training
sessions in excess of 15.
Continuous Cycling Peritoneal Dialysis (CCPD) Training (085X):
An ESRD facility may bill a maximum of 15 training sessions per patient for CCPD
training. The A/B MAC (A) will determine whether or not training sessions over 15 are
medically necessary.
Retraining
A. General - Occasionally, it is necessary to furnish additional training to an ESRD
self-dialysis beneficiary after the initial training course is completed. Retraining
sessions are paid under the following conditions:
•
The patient changes from one mode of dialysis to another, e.g., from
hemodialysis to CAPD;
•
The patient’s home dialysis equipment changes;
•
The patient’s dialysis setting changes;
•
The patient’s dialysis partner changes; or
•
The patient’s medical condition changes e.g., temporary memory loss due
to stroke, physical impairment.
The patient must continue to be an appropriate patient for self-dialysis.
B. Payment Rates - Retraining sessions are reimbursed at the same rate as the
facility’s training rate.
C. Duplicate Payments - No home dialysis training add-on payment is made for a
home dialysis treatment furnished on the same day as a retraining session. In the case
of a CAPD patient, the facility’s equivalent CAPD daily rate is not paid on the day(s)
of retraining.