Physician Services - Renal services
Physician services rendered to each outpatient maintenance
dialysis patient provided during a full month shall be billed on a monthly
capitation basis using the appropriate procedure code by age as outlined in the
CPT. Monthly maintenance dialysis payment (i.e., uninterrupted maintenance
dialysis) is comprehensive and covers most of a physician’s services whether a
patient dialyzes at home or in an approved ESRD outpatient facility. Dialysis
procedures are allowed in addition to the monthly maintenance dialysis payment.
In general, the Agency follows Medicare guidelines related to monthly capitation payments for physicians. Physician
services included in the monthly capitation payment for ESRD related services
include, but are not limited to:
• Assessment and determination of the need for outpatient
chronic dialysis therapy
• Assessment and determination of the type of dialysis
access and dialyzing cycle,
• Management of the dialysis visits including outpatient
visits for evaluation and management, management during the dialysis, and
telephone calls.
• Assessment and determination if a recipient meets
preliminary criteria as a renal transplant candidate including discussions with
family members
• Assessment for a specified diet and nutritional
supplementation for the control of chronic renal failure, including specifying
quantity of total protein, sodium, potassium, amount of fluids, types of anemia
and appropriate treatments, type of arthropathy or neuropathy and appropriate
treatment or referral, estimated ideal dry weight, etc.
