CMS Pub. 100-04, ch. 8, § 50.6.1

Furnished to Continuous Ambulatory Peritoneal Dialysis (CAPD)

/Continuous Cycling Peritoneal Dialysis (CCPD Home Dialysis Patients

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

Although Continuous Ambulatory Peritoneal Dialysis (CAPD) and Continuous Cycling

Peritoneal Dialysis (CCPD) patients are home dialysis patients, it may be necessary at

times to dialyze them in-facility as a substitute. In this case, the total weekly

reimbursement to the facility remains the same regardless of the type and frequency of in-facility dialysis involved.

In order to furnish covered CAPD services, a facility must be a Medicare approved

ESRD facility and must meet additional standards established by CMS.

However, in rare instances an ESRD patient may require a combination of dialysis

techniques, on the same day, in order to achieve satisfactory results. In these situations,

Medicare pays for both types of dialysis services furnished on the same day. Medicare

A/B MACs (A) determine the medical necessity. In each case the A/B MAC (A) obtains

medical documentation from the facility that supports the use of back-up dialysis with

another treatment modality. If a CAPD patient frequently requires back-up sessions, the

A/B MAC (A)’s medical staff may request medical records to determine if this is the

appropriate mode of treatment to meet medical necessity requirement for payment

purposes and/or whether a different mode of treatment is more advantageous to the

beneficiary.