CMS Pub. 100-04, ch. 12, § 190.3.4

The ESRD-related services included in the monthly capitation payment (MCP) with 2 or

3 visits per month and ESRD-related services with 4 or more visits per month may be

paid as Medicare telehealth services. However, at least 1 visit must be furnished face-to-face “hands on” to examine the vascular access site by a physician, clinical nurse

specialist, nurse practitioner, or physician assistant. An interactive audio and video

telecommunications system may be used for providing additional visits required under

the 2-to-3 visit MCP and the 4-or-more visit MCP. The medical record must indicate that

at least one of the visits was furnished face-to-face “hands on” by a physician, clinical

nurse specialist, nurse practitioner, or physician assistant.

The MCP physician, for example, the physician or practitioner who is responsible for the

complete monthly assessment of the patient and establishes the patient’s plan of care,

may use other physicians and practitioners to furnish ESRD-related visits through an

interactive audio and video telecommunications system. The non-MCP physician or

practitioner must have a relationship with the billing physician or practitioner such as a

partner, employees of the same group practice or an employee of the MCP physician, for

example, the non MCP physician or practitioner is either a W-2 employee or 1099

independent contractor. However, the physician or practitioner who is responsible for the

complete monthly assessment and establishes the ESRD beneficiary’s plan of care should

bill for the MCP in any given month.

Clinical Criteria

The visit, including a clinical examination of the vascular access site, must be conducted

face-to-face “hands on” by a physician, clinical nurse specialist, nurse practitioner or

physician’s assistant. For additional visits, the physician or practitioner at the distant site

is required, at a minimum, to use an interactive audio and video telecommunications

system that allows the physician or practitioner to provide medical management services

for a maintenance dialysis beneficiary. For example, an ESRD-related visit conducted

via telecommunications system must permit the physician or practitioner at the distant

site to perform an assessment of whether the dialysis is working effectively and whether

the patient is tolerating the procedure well (physiologically and psychologically). During

this assessment, the physician or practitioner at the distant site must be able to determine

whether alteration in any aspect of the beneficiary’s prescription is indicated, due to such

changes as the estimate of the patient’s dry weight.