Medicare Claims Processing Manual 
Chapter 8 - Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims 
Crosswalk 
Provider 
New New  Int.   Carrier  Reimburse 
Chap  Sect  Pub. 13  Pub. 14  HO 10  RDF 29  Part 1  PMs  Other  Description 
8  10  A3-3166      RDF-206  PRM1-2702      General Description of ESRD Payment 
8  10.1  A3-3166      RDF-245,  PRM1-2702      General Description of ESRD Facility 
RDF-245.2  Composite Rates  
8  10.2          PRM1-2702.1      Uncompleted Treatments 
8  10.3          PRM1-2702.1      No-Shows 
8  10.4        RDF-112,        Deductible and Coinsurance 
RDF-114 
8  10.5          PRM1-     Outpatient Hospital Services Which 
2702.1C  Become Inpatient Hospital Services 
8  10.6          PRM1-     Amount of Payment 
2706.1E 
8  10.7        RDF-221        ESRD Services Not Provided Within the 
United States 
8  10.8        RDF-207.4        Transportation Services 
8  20                Definitions Related to Calculating 
Composite Rate - section heading only 
8  30                Determination and Publication of 
Composite Rate - section heading only  Provider 
New New  Int.   Carrier  Reimburse 
Chap  Sect  Pub. 13  Pub. 14  HO 10  RDF 29  Part 1  PMs  Other  Description 
8  30.1          PRM1-2706.1,  42 CFR 413.172  Publication of Composite Rates 
PRM1-2704, 
PRM1-2706 
8  30.2          PRM1-2706.1      Determining Individual Facility 
Composite Rate 
8  30.3          PRM1-2705      Transition Period 
8  30.4          PRM1-2717      Record Keeping and Reporting 
Requirements Under Composite Rate 
System 
8  30.5          PRM1-2728      Facility Preparation and Intermediary 
Review of Cost Reports 
8  30.6          PRM1-2719      Issuance of Notice of Program 
Reimbursement 
8  40          PRM1-2720      Processing Requests for Composite Rate 
Exception 
8  50  A3-3644      RDF-207.1      CWF doc  In-Facility Dialysis Bill Processing 
Procedures 
8  50.1        RDF-207.1    A-03-33    Laboratory Services Included In the 
Composite Rate 
8  50.2  A3-3168A              Drugs and Biologicals Included In the 
Composite Rate 
8  50.3        RDF-320        Required Information for In-facility 
Claims Paid Under the Composite Rate  Provider 
New New  Int.   Carrier  Reimburse 
Chap  Sect  Pub. 13  Pub. 14  HO 10  RDF 29  Part 1  PMs  Other  Description 
8  50.3.1        RDF-320.1        Submitting Corrected Bills  
8  50.4  A3-3644.2              Non-Required Items on the Form 
CMS-1450 for ESRD Bills 
8  50.5  A3-3112.6              IPD in the Facility 
8  50.6        RDF-       In-Facility Back-Up Dialysis 
245.2D 
8  50.6.1  A3-3644.1,               Payment for In-Facility Maintenance 
A3-3171.1  Dialysis Sessions Furnished to 
CAPD/CCPD Home Dialysis Patients 
8  50.6.2  A3-3644.1              Payment for Hemodialysis Sessions  
8  50.7          PRM1-2702.2      Ultrafiltration 
8  50.8  A3-3112.6D    HO-E212.1    PRM1-2707,       Training and Retraining 
HO-E212.2,  PRM1-2707.1 
HO-E212.3, 
HO-E212.4 
8  50.9  A3-3644.5      RDF-319.3        Coding for Adequacy of Hemodialysis 
8  60          PRM1-2711      Separately Billable ESRD Items and 
Services 
8  60.1  A3-3644.1,  B3-4270.2     RDF-322  PRM1-2711.1      Lab Services 
A3-3167.3  
8  60.2  A3-3644F1-  B3-2231    RDF-319.1        Drugs Furnished in Dialysis Facilities 
A3-3644F5    Provider 
New New  Int.   Carrier  Reimburse 
Chap  Sect  Pub. 13  Pub. 14  HO 10  RDF 29  Part 1  PMs  Other  Description 
8  60.2.1                Billing Procedures for Drugs for 
Facilities 
8  60.2.2            AB-99-63     Drug Payment Amounts for Facilities 
8  60.2.3  A3-3644          AB-02-005    Use of Additional Codes by Facilities to 
Report Drugs 
8  60.2.4  A3-3644E       RDF-319.4        Intravenous Iron Therapy 
8  60.2.4.1  A3-3644              Facility Billing Requirements to the 
Intermediary  
8  60.2.4.2    B3-4461.1            Physician Billing Requirements to the 
B3-4461.2  Carrier 
B3-4461.3 
8  60.3  A3-3644G1-        PRM1-2711.3      Blood and Blood Services Furnished in 
A3-3644G3  Hospital Based and Independent Dialysis 
Facilities 
8  60.4  A3-3644D1-  B3-2049.3B1,    RDF-319,  PRM1- AB-00-76,    EPO 
D3,   B3-2049.5B  RDF- 2710.3A-D  A-01-106, 
207.5A-C,   AB 97-2  
8  60.4.1  A3-3644        PRM1-2710.3      EPO Facility Billing Requirements Using 
UB-92/Form CMS-1450 
8  60.4.2    B3-4273.1            EPO Supplier Billing Requirements 
(Method II) on the Form CMS-1500 
8  60.4.2.1    B3-4273.1            Other Information Required on the Form 
CMS-1500  Provider 
New New  Int.   Carrier  Reimburse 
Chap  Sect  Pub. 13  Pub. 14  HO 10  RDF 29  Part 1  PMs  Other  Description 
8  60.4.2.2    B3-4273.2            Completion of Subsequent Form 
CMS-1500 Claims for EPO 
8  60.4.3  A3-3644              Payment Amount 
8  60.4.3.1  A3-3644              Payment in Other Settings 
8  60.4.3.2            A-01-106    Hospital Outpatient Departments 
8  60.4.4    B3-4270.1            Home Patients 
8  60.4.4.1    B3-4270.1            Self Administered EPO Supply 
8  60.5          PRM1-2711.6      Intradialytic Parenteral/Enteral Nutrition 
(IDPN) 
8  60.6          PRM1-2711.4      Hepatitis B Vaccine Furnished to ESRD 
Patients 
8  70  A3-3644  B3-4270.1      PRM1-   RO2 3440.2  Payment for Home Dialysis 
A3-3169  2706.1E,  
PRM1-2706.2, 
8  70.1    B3-4271      PRM1-2740.2      Method Selection for Home Dialysis 
Payment 
8  70.1.1          PRM1-     Change in Method 
2740.2D 
8  70.2          PRM1-2740.3      Prevention of Double Billing Under 
Method I and II 
8  70.3          PRM1-2740.4      Overpayments  Provider 
New New  Int.   Carrier  Reimburse 
Chap  Sect  Pub. 13  Pub. 14  HO 10  RDF 29  Part 1  PMs  Other  Description 
8  80  A3-3644A,  B3-4270    RDF-318  PRM1-2710,     RO2 3440  Home Dialysis Method I Billing to the 
A3-3169,   B3-4271  PRM1-2710.4,  Intermediary 
8  80.1  A3-3169.1        PRM1-2712      Items and Services Included in the 
Composite Rate for Home Dialysis 
8  80.2  A3-3644            CWF doc.   General Intermediary Bill Processing 
Procedures for Method I Home Dialysis 
Services 
8  80.2.1  A3-3644.2              Required Billing Information for Method 
I Claims 
8  80.3  A3-3112.6        PRM1-2709,       Calculating Intermediary Payment for 
PRM1- Intermittent Peritoneal Dialysis (IPD) for 
2709.1A,   Method I 
PRM1-2709.2, 
8  80.3.1          PRM1-     IPD at Home for Method I Claims 
2709.1B  Submitted to the Intermediary 
8  80.4  A3-3644.1        PRM1-2709.2      Calculating Payment for Continuous 
Ambulatory Peritoneal Dialysis (CAPD) 
and Continuous Cycling Peritoneal 
Dialysis (CCPD) Under the Composite 
rate 
8  90  A3-3644A,   B3-4270,      PRM1-2740    RO2 3440C  Method II Billing  
A3-3644.3   B3-4271, 
B3-4270.1, 
B3-4270.2, 
B3-4271  Provider 
New New  Int.   Carrier  Reimburse 
Chap  Sect  Pub. 13  Pub. 14  HO 10  RDF 29  Part 1  PMs  Other  Description 
8  90.1  A3-3170.6,   B3-2231.3A  HO-238.2C    PRM1-     DMERC Denials for Beneficiary 
A3-3644.3,   &B,  HO-238.3,  2709.2A   Submitted Claims Under Method II 
A3-3644.3A-E    B3-2231,   HO-238.3A 
B3-4270.1,  
8  90.2    B3-4270.1,            Requirements For Payment by the 
B3-3045.7   DMERC 
8  90.2.1    B3-4270.1            Supplier Documentation Required  
8  90.2.2    B3-4270.1            DMERC Letter Explaining Requirements 
to Method II Supplier 
8  90.3    B3-3045.7        B-01-56     Amount of Payment by the DMERC 
8  90.3.1    B3-3045.7            Billing Instructions for Method II to 
DMERCs 
8  90.3.2    B3-4270        B-01-56    Home Dialysis Supplies and Equipment 
HCPCS Codes Used to Bill the DMERC 
8  90.3.3    B3-3045.7C            DMERC Claims Processing Instructions  
8  90.4                Equipment and Equipment Related 
Services Provided to Direct Dealing 
Beneficiary 
8  90.5  A3-3644.3C,        PRM1-2740.1,      Method II Support Services Billed to the 
A3-3644.3D   PRM1-2743.1   Intermediary by the Facility  
8  90.5.1  A3-3644.3E,      RDF-321        Billable UB-92 Revenue Codes Under 
Method II 
8  90.5.1.1  A3-3644.3E               Unbillable UB-92 Revenue Codes Under 
Method II  Provider 
New New  Int.   Carrier  Reimburse 
Chap  Sect  Pub. 13  Pub. 14  HO 10  RDF 29  Part 1  PMs  Other  Description 
8  100  A3-3169.3       RDF-245.2E  PRM1-2713    RO-2  Dialysis Sessions Furnished to Patients 
3440.3,   Who are Traveling 
8  100.1          PRM1-2713.1      Traveling Patients Who are Normally In-
facility Dialysis Patients 
8  100.2    B3-4271.1,      PRM1-2713.2,      Traveling Patients Who are Normally 
B3-4272  Home Dialysis  
8  100.3    B3-4272.4            Physician's Services Furnished to a 
Dialysis Patient Away from Home or 
Usual Facility 
8  110  A3-3644c1,         PRM1-2706.2      Reduction in Medicare Program Payment 
A3-3644c3,   to Fund ESRD Networks 
8  120          PRM1-2770      Renal Transplantation and Related 
Services 
8  120.1    B3-4471      PRM1-2711.5,  AB-01-10    Payment for Immunosuppressive Drugs 
Furnished to Transplant Patients 
8  130    B3-4270            Physicians and Supplier (non-facility) 
Billing for ESRD Services - General 
8  130.1    B3-4275,       PRM1-2715,       Initial Method for Physician's Services to 
B3-4275.1,   PRM1-2715.1,  Maintenance Dialysis Patients 
B3-4275.2  PRM1-2715.2   Provider 
New New  Int.   Carrier  Reimburse 
Chap  Sect  Pub. 13  Pub. 14  HO 10  RDF 29  Part 1  PMs  Other  Description 
8  140    B3-15060,             Monthly Capitation Payment Method for 
B3-15060.1   Physicians' Services Furnished to Patients 
B3-15060.2   on Maintenance Dialysis 
B3-15060.3  
B3-15060.4 
B3-15060.5  
B3-15350  
B3-2230.3  
B3-2230.6 
B3-4272 
B3-4272.1,  
B3-4272.2 
8  140.1    B3-4272.1            Services Included in Monthly Capitation 
Payment 
8  140.2    B3-4272            Services Excluded from Monthly 
Capitation Payment 
8  140.3    B3-4272.2            Data Elements Required on Claim for 
Monthly Capitation Payment 
8  140.4    B3-4272.3            Controlling Claims Paid Under the 
Monthly Capitation Payment Method 
8  140.5    B3-15060.3            Determining Monthly Capitation 
Payment Amount for Physician's Services 
to Maintenance Dialysis Patients  
8  140.5.1    B3-15060.4            Temporary Absence Under MCP 
8  150    B3-15060.5            Physician's Self-Dialysis Training 
Services  Provider 
New New  Int.   Carrier  Reimburse 
Chap  Sect  Pub. 13  Pub. 14  HO 10  RDF 29  Part 1  PMs  Other  Description 
8  160    B3-15062.1,             Payment for Physician's Services 
B3-4275   Furnished to Dialysis Inpatients 
8  160.1    B3-15062.1            Determining Whether Physician Services 
Furnished on Day of Dialysis 
8  160.2    B3-15062.1            Physicians' Services Furnished on Day of 
Dialysis 
8  160.3    B3-15062.1            Physicians' Services Furnished on Non-
Dialysis Days 
8  160.4    B3-15062.1            Requirements for Payment 
8  170    B3-15350,            Billing Physician Dialysis Services 
R1810B3  (codes 90935 - 90999) and Related 
Payment 
8  180            AB-01-189,    Non-Invasive Studies for ESRD Patients 
AB-03-001  - Facility and Physician Services