CMS Pub. 100-04, ch. 6, § 20.2.1

ESRD

(Rev. 4001, Issued: 03-16-18, Effective: 06-19-18, Implementation: 06-19-18)

Beneficiaries with ESRD may receive dialysis and dialysis related services from a

hospital-based or free-standing RDF, or may receive home dialysis supplies and

equipment from a supplier. The following services are excluded from SNF CB:

• Certain dialysis services and supplies, including any related necessary ambulance

services;

• Home dialysis supplies and equipment, self-care home dialysis support services,

and institutional dialysis services and supplies (other than those furnished or

arranged for by the SNF itself) are not included in the SNF Part A PPS rate. These

services may be billed separately to the A/B MAC (A) by the ESRD facility as

appropriate; dialysis supplies and equipment may be billed to the Durable

Medical Equipment Medicare Administrative Contractor (DME MAC) by the

supplier; and

• Erythropoiesis Stimulating Agents (ESAs) for certain dialysis patients, subject to

methods and standards for its safe and effective use (see 42 CFR 494.80(a)(2) and

(a)(4), 494.90(a)(4), and 494.100) may be billed by the RDF to the A/B MAC

(A), or by the retail pharmacy to the DME MAC.

By contrast, services that fall outside the scope of the Part B dialysis benefit do not

qualify for the dialysis exclusion from SNF CB. Similarly, the SNF CB exclusion

described above for ESAs does not encompass situations involving their use for a non-dialysis purpose (such as ameliorating the side effects of chemotherapy treatments). The

Part B dialysis benefit generally does not cover dialysis for those beneficiaries who do

not have ESRD. However, an exception involves “acute” dialysis (HCPCS code G0491),

for patients who do not have ESRD but require dialysis temporarily following an acute

kidney injury (AKI) from a severe medical trauma (such as a drug overdose or a traffic

accident). In contrast to maintenance dialysis for ESRD patients (who, in the absence of a

kidney transplant, would remain on periodic dialysis indefinitely), there is an expectation

with acute dialysis that the patient’s own kidneys will eventually recover and resume

their normal function. For services furnished on or after January 1, 2017, section 808(a)

of Public Law 114-27 added acute dialysis to the scope of the Part B dialysis benefit,

thereby effectively adding such services to the scope of the dialysis exclusion from SNF

CB as well.