CMS Pub. 100-04, ch. 8, § 10.5

Outpatient dialysis services for a patient with acute kidney failure or chronic kidney

failure but not eligible for Medicare under the ESRD provisions at the time services are

rendered must be billed by the hospital and cannot be billed by a Medicare certified renal

dialysis facility on bill type 72x.

Hospitals with a Medicare certified renal dialysis facility should have outpatient ESRD

related services billed by the hospital-based renal dialysis facility on bill type 72x.

Hospitals that do not have a Medicare certified renal dialysis facility may bill for

outpatient emergency or unscheduled dialysis services. The Prospective Payment System

(PPS) base rate is not paid. For more information regarding the outpatient hospital billing

policy for ESRD related services, see chapter 4 section 210 of this manual.

When an individual is furnished outpatient hospital services and is thereafter admitted as

an inpatient of the same hospital due to renal failure - within 24 hours for non PPS

hospitals and within 72 hours for PPS hospitals - the outpatient hospital services

furnished are treated as inpatient services unless the patient does not have Part A

coverage. Charges are reported on the ASC X12 837 institutional claim format or on

Form CMS-1450. The day on which the patient is formally admitted as an inpatient is

counted as the first inpatient day. The PPS base rate is not paid.