CMS Pub. 100-04, ch. 8, § 10

Payment System (ESRD (PPS)

(Rev. 10640, Issued:08-06-21, Effective:09-07-21, Implementation:09-07-21)

See the Medicare Benefit Policy Manual, Chapter 11, for a general description of

coverage policies and definitions relating to the ESRD benefit.

Effective January 1, 2011 Section 153b of the Medicare Improvements for Patients and

Providers (MIPPA) requires the implementation of End Stage Renal Disease Prospective

Payment System (ESRD PPS). The ESRD PPS provides a single payment to ESRD

facilities that will cover all of the resources used in furnishing an outpatient dialysis

treatment, including supplies and equipment used to administer dialysis (in the ESRD

facility or at a patient’s home), drugs, biologicals, laboratory tests, training, and support

services.

All ESRD related services and supplies are paid to the ESRD facility through the

ESRDPPS. Other entities providing ESRD related services, including laboratories,

suppliers and physicians billing for ESRD related drugs must look to the ESRD facility

for payment. Consolidated Billing edits established with the implementation of the ESRD

PPS will deny or reject claims to other providers and suppliers billing for ESRD related

labs, drugs and supplies.

Information related to the lab tests, drugs and supplies subject to the ESRD consolidated

billing requirement can be found at the following website:

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-

Payment/ESRDpayment/Consolidated_Billing.html

The list of items and services subject to consolidated billing may be updated quarterly in

January, April, July and October of each year.