Installation and Delivery Charges for ESRD Equipment

ESRD facilities are responsible for all reasonable and necessary expenses incurred in the initial installation of home dialysis equipment, but not those expenses attributable to items that are basically for the purpose of improving the patient's home, e.g., plumbing or electrical work beyond that necessary to tie in with existing power or water lines.

The delivery and installation of renal dialysis equipment, unlike that involved when a hospital bed is delivered and set up, requires testing and assurance of equipment performance. Therefore, if the supplier of home dialysis equipment customarily charges
for delivery and service, and this is a common practice among other suppliers as well, this is payable.

Elimination of Method II Home Dialysis

Effective for dates of service on and after January 1, 2011, Section 153b of the Medicare Improvements for Patients and Providers Act (MIPPA) eliminated Method II home dialysis claims. Specifically, Method II home dialysis is no longer recognized as a beneficiary option for dates of services beginning January 1, 2011, therefore, all ESRD patients that previously selected Method II are covered under Method I. All home dialysis claims must be billed by an ESRD facility and paid under the ESRD PPS. As a result, the submission of the CMS-382 form to the Medicare contractors is no longer required for home dialysis patients on or after January 1, 2011.

Method II claims will not be accepted for dates of service on or after January 1, 2011. Method II claims for dates of service prior to January 1, 2011 will continue to be processed within normal timely filing limitations. For more information on timely filing, see Pub. 100-04, Chapter 1, Sections 70 through 70.8.6.

For dates of service on or after January 1, 2011, contractors shall continue to allow separate billing for certain ESRD supply HCPCS codes subject to the ESRD PPS consolidated billing requirements when submitted by suppliers for services not related to the beneficiary’s ESRD dialysis treatment and billed with the modifier AY. Contractors shall pay for ESRD supplies subject to ESRD CB when billed on a CMS-1500 or electronic equivalent if the ESRD supply claims contain modifier AY. A list of equipment and supplies eligible for separate payment when billed with modifier AY can be found in the first table (DME ESRD Supply HCPCS for ESRD PPS Consolidated Billing Edits) of the document titled “Items and Services Subject to Consolidated Billing for the ESRD PPS” located at the ESRD Payment website: http://www.cms.gov/ESRDPayment/50_Consolidated_Billing.asp#TopOfPage.

Some equipment and supplies are ESRD-related but are not used in other provider settings and will, therefore, never be used for reasons other than for the treatment of ESRD. These equipment and supplies can be found listed in the second table (DME ESRD Supply HCPCS Not Payable to DME Suppliers) of the document titled “Items and Services Subject to Consolidated Billing for the ESRD PPS” located at the ESRD Payment website: http://www.cms.gov/ESRDPayment/50_Consolidated_Billing.asp#TopOfPage. DME suppliers will not be capable of billing and being paid for any of the supplies on this list using the AY modifier.

Determination of ESRD Method Selection

A. Method Selection and Form CMS-382

For services furnished prior to January 1, 2011, the beneficiary was required to complete Form CMS-382 to choose either Method I or Method II dialysis. Method I dialysis patients receive their home dialysis equipment and supplies from a dialysis facility. Method II patients chose to deal with a home dialysis supplier that is not a dialysis facility. Once a beneficiary made a method selection choice, the beneficiary or dialysis facility submitted the Form CMS-382 to the appropriate FI. The FI then processed information from the form to CWF. Chapter 8 provided the instructions for completing the form.

For dates of service prior to January 1, 2011, the DME MACs deny Method II claims where there is no method selection or the method selection has a value of '1' on file at CWF.

For dates of service on and after January 1, 2011, please refer to Section 30.8.3 for information on the elimination of Method II home dialysis.

B. Changes in Method Selection

Prior to the implementation of the ESRD PPS, for dates of service prior to January 1, 2011, if a beneficiary decided to change his or her choice of method selection, he or she filled out a new Form CMS-382 to indicate the change. The beneficiary could have filled out a new method selection form at any time, but in most circumstances, the change did not take effect until January 1 of the following calendar year. If a beneficiary requested an exception to the January 1 implementation date in writing from the FI, the FI could have chosen to grant his or her request. See Chapter 8 for related requirements.

The DME MAC systems must be able to interpret the CWF trailer record that contains the method effective date.
For dates of service on and after January 1, 2011, please refer to Section 30.8.3 for information on the elimination of Method II home dialysis.