US · guidance
CMS Pub. 100-04, ch. 8, § 130
Physicians and Supplier (Nonfacility) Billing for ESRD Services -
General
(Rev. 3053, Issued: 08-28-14, Effective: ICD-10: Upon Implementation of ICD-10; ASC X12: 01-01, 12, Implementation ICD-10: Upon Implementation of ICD-10; ASC X12: 09-30-14)
Payment for renal-related physicians’ services to ESRD patients is made in either of the
following ways:
• Under the Monthly Capitation Payment (MCP) (see §140 below for an
explanation of the MCP); or
• Using the daily codes for ESRD services (CPT codes 90922-90925) with units
that represent the number of days services were furnished.
• Under the Initial method (IM)
The A/B MAC (B) receives bills from physicians for services furnished ESRD
beneficiaries.
The A/B MAC (A) receives bills from ESRD facilities.
Lab bills from CLIA certified independent dialysis facilities were billed to the A/B MAC
(B) before September 1, 1997, and to the A/B MAC (A) beginning on that date. Other
certified labs bill the A/C MAC (B).
History
(Rev. 3053, Issued: 08-28-14, Effective: ICD-10: Upon Implementation of ICD-10; ASC X12: 01-01, 12, Implementation ICD-10: Upon Implementation of ICD-10; ASC X12: 09-30-14)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
706b0ada24843b5c78c722e8e9a345b6ffcef3839c439b62196401b0b5a146b1
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