CMS Pub. 100-02, ch. 11, § 20.1

Beginning January 1, 2011, all renal dialysis services (defined at §10.C of this chapter) are included in the

ESRD PPS. Renal dialysis services include, but are not limited to, the items and services included under the

composite rate as of December 31, 2010.

Historically the composite payment rate (defined at §10.G.3 of this chapter) was the methodology for paying

for dialysis services. The composite rate was a comprehensive payment for all modes of in-facility and

home dialysis. On January 1, 2011, the composite rate was incorporated into the ESRD PPS payment

methodology. Most items and services related to the treatment of the patient’s end-stage renal disease were

covered under the composite rate payment, except physicians’ professional services, separately billable

laboratory services, and separately billable drugs. If a facility, either directly or under an arrangement,

failed to furnish any part of the items and services covered under the composite rate, then the ESRD facility

could not be paid any amount for the service. This payment was subject to the normal Part B deductible and

co-insurance requirements.

Below are examples of items and services included under the composite rate and furnished, either directly or

under arrangement, by the ESRD facility.

• Dialysate;

• Cardiac monitoring;

• Catheter changes;

• Suture removal;

• Dressing changes;

• Crash cart usage for cardiac arrest;

• De-clotting of shunt performed by ESRD facility staff in the dialysis unit;

• All oxygen and its administration furnished in the dialysis unit;

• Staff time to administer blood;

• Staff time to administer separately billable parenteral items; and

• Staff time to collect specimens for laboratory tests.