CMS Pub. 100-02, ch. 11, § 30.2

Self-dialysis and home dialysis training are programs provided by Medicare certified ESRD facilities that

educate ESRD patients and their caregivers to perform self-dialysis in the ESRD facility or home dialysis

(including CAPD and CCPD) with little or no professional assistance. Self-dialysis training can occur in the

patient’s home or in the facility when it is provided by the qualified staff of the ESRD facility. CMS

expects that the patients who elect home dialysis are good candidates for home dialysis training, and

therefore, will successfully complete their method of training before reaching the maximum number of

sessions allotted. Dialysis training services are paid for in accordance with Pub. 100-04, Medicare Claims

Processing Manual, chapter 8, §50.8.

Effective January 1, 2025, ESRD facilities may bill for the home and self-dialysis add-on training

adjustment described at §60.C.1 for training sessions for AKI patients.

Home dialysis training services and supplies may include, but are not limited to, personnel services; dialysis

supplies, parenteral items used in dialysis, written training manuals and materials, and renal dialysis

laboratory tests. For more information on the requirements for ESRD facilities, see 42 CFR Part 494.

An ESRD facility may bill a maximum of 25 training sessions per patient for hemodialysis training and 15

sessions for CCPD and CAPD. For information on how home dialysis training treatments are paid, see

§60.C.1 of this chapter.

NOTE: ESRD facilities that are certified for home dialysis training and support services are expected to

provide training throughout the home dialysis experience. Information regarding home dialysis training

certification may be found at the following link: http://www.cms.gov/Medicare/Provider-Enrollment-and-

Certification/GuidanceforLawsAndRegulations/Dialysis.html.

A. Hemodialysis Training

The average training time for hemodialysis is based upon 5-hour sessions given 3 times per week. Training

programs are designed to accommodate the caregiver and the beneficiary when appropriate. Specifically,

both can be trained to perform the dialysis treatment in its entirety. Sometimes the beneficiary plays a

secondary role. In other programs, the beneficiary performs most of the treatment and is only aided or

overseen by their caregiver.

B. Peritoneal Dialysis (PD) Training

The home peritoneal dialysis training is covered for up to 15 sessions. Additional CAPD training sessions

are covered only when documented as being reasonable and necessary. However, extra training sessions

raise questions about either the adequacy of PD for the patient or the patient’s capacity to learn or perform

the PD technique. The patient’s physician should address these questions in the explanation of the need for

extra training sessions. The MAC will make a determination whether or not to cover training sessions in

excess of 15.

1. Continuous Ambulatory Peritoneal Dialysis (CAPD) Training

The CAPD training is furnished in sessions that can last up to 8 hours (one session per day) 5 - 6 days per

week. Typically, 6 - 8 CAPD exchanges can be performed per day for the purpose of teaching the patient

the CAPD technique; however, no specific number of exchanges is required. Normally patients are trained

within 2 weeks (5 - 6 training sessions per week); however, up to 15 sessions (i.e., 15 training days) may be

covered routinely.

Supplemental Dialysis during CAPD Training

It may be necessary to supplement the patient’s dialysis during CAPD training with intermittent peritoneal

dialysis, because the patient has not yet mastered the CAPD technique. Generally, no more than three

supplemental intermittent peritoneal dialysis sessions are required during the course of CAPD training, and

these may be covered routinely. If more than three sessions are billed during training, the claims must be

documented for medical necessity. Under certain circumstances, the form of supplemental dialysis may be

hemodialysis.

Once the patient is trained, CAPD is primarily a home service, because the patient performs CAPD 24

hours a day. Persons who are primarily treated by CAPD may also require in-facility dialysis, either

intermittent peritoneal or hemodialysis, occasionally.

2. Continuous Cycling Peritoneal Dialysis (CCPD) Training

Continuous cycling peritoneal dialysis training is furnished in sessions of 8 hours per day 5 days per week.

Typically, five exchanges can be performed per day to teach the patient the technique; however, no specific

number of exchanges is required. Most patients are trained within 2 weeks; however, up to 15 sessions may

be covered routinely. The A/B MAC (A) will determine whether or not training sessions over 15 are

medically necessary.

3. Retraining

Payment is made for retraining self-dialysis education after a patient or caregiver has completed the initial

program if the patient continues to be an appropriate candidate for home dialysis. Most patients receive

additional training on the use of new equipment or upon a change in their caregiver, or a change in modality.

The ESRD facility may not bill for retraining services when they install home dialysis equipment or furnish

monitoring services. For example, an ESRD facility nurse may not bill for retraining sessions to update

treatment records, order new supplies, or add additional medicine for the treatment of infection.

NOTE: When retraining and educational services are furnished to a patient or caregiver already

knowledgeable in some other form of self-dialysis or if training is being done for a change of equipment,

fewer sessions are necessary because of the transferability of certain basic skills.

Criteria for retraining are explained in greater detail in Pub. 100-04, Medicare Claims Processing Manual,

chapter 8, §50.8.