CMS Pub. 100-02, ch. 15, § 310

By definition, chronic kidney disease (CKD) is kidney damage for 3 months or longer,

regardless of the cause of kidney damage. CKD typically evolves over a long period of

time and patients may not have symptoms until significant, possibly irreversible, damage

has been done. Complications can develop from kidneys that do not function properly,

such as high blood pressure, anemia, and weak bones. When CKD progresses, it may

lead to kidney failure, which requires artificial means to perform kidney functions

(dialysis) or a kidney transplant to maintain life.

Patients can be classified into 5 stages based on their glomerular filtration rate (GFR,

how quickly blood is filtered through the kidneys), with stage I having kidney damage

with normal or increased GFR to stage V with kidney failure, also called end-stage renal

disease (ESRD). Once patients with CKD are identified, treatment is available to help

prevent complications of decreased kidney function, slow the progression of kidney

disease, and reduce the risk of other diseases such as heart disease.

Beneficiaries with CKD may benefit from kidney disease education (KDE) interventions

due to the large amount of medical information that could affect patient outcomes,

including the increasing emphasis on self-care and patients’ desire for informed,

autonomous decision-making. Pre-dialysis education can help patients achieve better

understanding of their illness, dialysis modality options, and may help delay the need for

dialysis. Education interventions should be patient-centered, encourage collaboration,

offer support to the patient, and be delivered consistently.

Effective for claims with dates of service on and after January 1, 2010, Section 152(b) of

the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) covers

KDE services under Medicare Part B. KDE services are designed to provide

beneficiaries with Stage IV CKD comprehensive information regarding: the management

of comorbidities, including delaying the need for dialysis; prevention of uremic

complications; all therapeutic options (each option for renal replacement therapy, dialysis

access options, and transplantation); ensuring that the beneficiary has opportunities to

actively participate in his/her choice of therapy; and that the services be tailored to meet

the beneficiary’s needs.

Regulations for KDE services were established at 42 CFR 410.48. Claims processing

instructions and billing requirements can be found in Pub. 100-04, Medicare Claims

Processing Manual, Chapter 32 – Billing Requirements for Special Services, Section 20.