Ga. Medicaid Part II Policies & Procedures for Hospital Services § 908

Hospital-based dialysis facilities must be separately enrolled in the Dialysis Services Program to receive

reimbursement for maintenance dialysis services provided to members with End Stage Renal Disease

(ESRD). Routine maintenance dialysis services are not covered in the Hospital Program

ESRD services that are required when the member’s regular dialysis facility is closed must be billed

directly to the facility normally providing these services.

To receive reimbursement, the hospital must have an agreement with the dialysis

facility to provide these services if the facility is closed.

Inpatient dialysis services are covered for acute renal failure. If a certified dialysis facility

performs ESRD services for the patient while admitted to the hospital, the dialysis facility must bill

Medicaid for services rendered. If an ESRD patient is provided emergency services as an

outpatient because the

dialysis facility is closed, the hospital must bill the patient’s usual dialysis facility for services provided

Only revenue codes 801, 802, 803, 804, 880 and 881 will be covered in the Hospital Program.

Reimbursement for maintenance dialysis to hospitals that do not have a hospital-based dialysis facility

and for dialysis services provided in cases of acute renal failure will be included in the Diagnosis

Related Grouping (DRG) reimbursement rate.

Inpatient maintenance dialysis services provided by hospitals with a hospital- based dialysis facility

must be billed to the Dialysis Services Program. Reimbursement will be pro-rated at 1/30th of the

allowed composite rate for each day of service.