US · guidance
CMS Pub. 100-04, ch. 8, § 140.1.2
Patients Who Switch Modalities (Center to Home and Vice
Versa)
(Rev. 1999, Issued: 07-09-10, Effective: 01-01-11, Implementation: 01-03-11)
If a home dialysis patient receives dialysis in a dialysis center or other outpatient facility
during the month, the MCP physician or practitioner is paid the management fee for the
home dialysis patient and cannot bill the ESRD-related services codes for managing
center based patients.
This situation should be coded using the ESRD–related services codes for a home
dialysis patient per full month. Physicians and practitioners should use the ESRD–related
services codes for a home dialysis patient per full month when billing for outpatient
ESRD-related services when a home dialysis patient receives dialysis in a dialysis center
or other outpatient facility during the month.
Physicians and practitioners should use the ESRD–related services codes for a home
dialysis patient per full month for patients that switch modalities regardless of whether
the ESRD beneficiary went from home dialysis to center-based dialysis, or vice versa,
and regardless of the proportion of the month that the beneficiary was receiving each
modality.
History
(Rev. 1999, Issued: 07-09-10, Effective: 01-01-11, Implementation: 01-03-11)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
c7e2bfa5aaf595d10437dd3f428287aaee9ffededb20e9b58dab06d3efeaf4c2
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