Period of Medical Necessity - Home Dialysis Equipment

5.12 – Period of Medical Necessity - Home Dialysis Equipment (Rev. 10749; Issued: 05-11-21; Effective: 06-11-21; Implementation: 06-11-21) Situations may occur causing temporary non-use of equipment: • Beneficiary requires in-facility treatment for re-stabilization or as a result of some acute condition. The beneficiary is expected to return to home dialysis; • Beneficiary is temporarily without a suitable home dialysis assistant; • Beneficiary is away from home but expects to return; or • Beneficiary is a transplant candidate and is taken off home dialysis preparatory to transplant. (If the transplant cannot occur, or if the transplant is not successful, the patient will very likely resume home dialysis and an evaluation can be made whether it will be within the immediate or foreseeable future.) Under such circumstances, DME MACs or UPICs determine that medical necessity exists and pay for a period of up to 3 months after the month home dialysis equipment was last used. This does not eliminate the necessity for periodic reevaluation of medical necessity. It provides a tolerance to avoid frequent reevaluation in renal dialysis situations and provides for continuity of payments where economically advantageous.