CMS Pub. 100-04, ch. 8, § 160.2

B3-15062.1

Supervision or direction of a dialysis treatment by a physician does not ordinarily meet

the requirements for physicians’ services and, therefore, is not paid for as such under the

fee schedule. However, physicians are responsible for the medical care and treatment of

the dialysis patients. Physicians’ services furnished to those patients that meet the

requirements and are medically necessary are covered. The hospital medical record must

document the services furnished and the medical reasons for them.

Generally, claims from the physician receiving a procedure code payment for additional

services furnished to the same patient on the day of dialysis must be reviewed by medical

staff prior to payment. Follow §170.B for dialysis and evaluation and management

services performed on the same day.

Payment in addition to the procedure code payment is made only if the service is not

related to the treatment of the patient’s ESRD, and the service was not, and could not

have been, furnished during the dialysis treatment. However, an exception to this rule is

physicians’ surgical services; e.g., catheter insertion. Physicians’ surgical services are

generally billed under the appropriate procedure code for payment. If more than one

physician furnishes care to the same dialysis patient, follow the usual coverage rules on

concurrent care.