Professional Services

Professional Services A. The Division of Medicaid covers related physician services for ESRD billed with the appropriate procedure codes which are excluded from the ESRD PPS rate. 1. The physician or qualified health care professional must provide one (1) face-to-face visit with the beneficiary monthly. 2. The medical record must contain the physician or qualified health care professional’s documentation substantiating the medical necessity for additional face-to-face visits. 3. Documentation must be legibly written, signed and dated during the face-to-face visit. 4. Documentation by the interdisciplinary team cannot substantiate the medical necessity of the physician or qualified health care professional’s face-to-face visit. B. Physician services are not covered under the facility’s provider number. C. Face-to-face physician visits are not included in the physician services visit limit. D. Evaluation and management services provided to the beneficiary which are unrelated to dialysis services cannot be performed during the dialysis session and must be reported separately.