Items and Services Included in the ESRD PPS payment for Home

80.1 - Items and Services Included in the ESRD PPS payment for Home Dialysis (Rev. 10640, Issued:08-06-21, Effective:09-07-21, Implementation:09-07-21) The following items are paid for and must be furnished under the PPS. The facility may furnish them directly under arrangements, to all of its home dialysis patients. If the facility fails to furnish (either directly or under arrangements) any part of the items and services covered under the rate, then the facility cannot be paid any amount for the part of the items and services that the facility does furnish. • Medically necessary dialysis equipment and dialysis support equipment; • Home dialysis support services including the delivery, installation, maintenance, repair, and testing of home dialysis equipment, and home support equipment; • Purchase and delivery of all necessary dialysis supplies; • Routine ESRD related laboratory tests; and • All dialysis services furnished by the facility’s staff. The following items and services are included in the ESRD PPS and may not be billed separately when furnished by a dialysis facility: • Staff time used to administer blood; • Declotting of shunts and any supplies used to declot shunts by facility staff in the dialysis unit; • Oxygen and the administration of oxygen furnished in the dialysis unit; • Staff time used to administer separately billable parenteral items; • Bicarbonate dialysate; • Cardiac monitoring; • Catheter changes (Ideal Loop); • Suture removal; • Dressing changes; • Crash cart usage for cardiac arrest; or • Staff time used to collect specimens for all laboratory tests. Sometimes services that are not renal dialysis services (e.g., declotting of shunts, suture removal, injecting separately billable ESRD related drugs) are furnished in a department of the hospital other than the dialysis unit (e.g., the emergency room). These services may be paid in addition to the ESRD PPS payment only if the services could not be furnished in a dialysis facility or the dialysis unit of the hospital, due to the absence of specialized equipment or staff, which can be found only in the other department. In the case of emergency services furnished in the hospital emergency room (ER), the services are paid separately subject to the additional requirement that there is a sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention in the ER could reasonably be expected to result in either: • Placing the patient’s health in serious jeopardy; • Causing serious impairment to bodily functions; or • Causing serious dysfunction of any bodily organ or part. These situations are rare and, in the absence of documentation to the contrary, these conditions are deemed to be not met.