Effective Jan. 1, 2020, the title of Clinical Coverage Policy 1A-34 changed to Dialysis Services. In addition to the title change, the Division of Health Benefits will now cover services for Acute Kidney Injury (AKI).
The following additions, deletions and clarifications were added to the policy:
- Hospital-based and freestanding End-Stage Renal Disease (ESRD) facilities are reimbursed for renal dialysis services furnished to beneficiaries with AKI for both adult and pediatric beneficiaries.
- Services furnished to beneficiaries with an AKI or ESRD diagnosis shall be reimbursed with the same payment methodology as freestanding ESRD facilities.
- Treatment reimbursement is allowed once per day per beneficiary across settings. In the instance of an uncompleted or partial treatment, additional payment may be allowed.
- Home and self-dialysis services will remain reimbursable for ESRD diagnosis only.
- ESRD facilities shall report all items and services furnished to beneficiaries with AKI using condition code 84 - Dialysis for AKI.
- NDC codes are to be submitted on claims for vaccines.
- Drugs that are not listed as ‘included in the composite rate’ are to be billed separately. Refer to the Physician Administered Drug Program Fee Schedule, as well as Billing Guidelines in Medicaid Bulletins to determine if the drug can be billed with the ESRD Treatment Facility Place of Service.
- Self-dialysis training codes are to be billed by the provider, rather than the ESRD facility.
- Monthly co-payments are required for Dialysis Services.
- Please resubmit Dialysis Services claims with a diagnosis of Acute Kidney Injury for dates of service on or after Jan. 1, 2020, for reprocessing that have denied.
Please refer to Clinical Coverage Policy 1A-34.
Contact
NCTracks Contact Center: 800-688-6696