Dialysis
End stage renal disease (ESRD) services, hemodialysis, peritoneal dialysis, treatment for acute kidney injury (AKI), and other dialysis services and supplies are covered. Covered services include medically necessary and appropriate:
- Inpatient dialysis treatments
- Outpatient dialysis treatments and individual professional provider services
- Home dialysis, including home dialysis training and home dialysis equipment and supplies (Dialysis training must be documented in the medical record.)
- Other drugs, services and supplies that are required as part of the dialysis care (for example, laboratory services)
The attending or prescribing individual professional provider must document the frequency of dialysis services in the patient's medical record and plan of care.
Services provided by dialysis aides, attendants and assistants are not covered.
Note: TRICARE-authorized freestanding kidney dialysis facilities are reimbursed at a per-session rate, which includes the drugs, services and supplies that are required as part of dialysis care. Refer to the Centers for Medicare & Medicaid Services' ESRD PPS Consolidated Billing page to identify services and supplies included in the per-session rate that are not eligible for separate payment.
See also our Freestanding Kidney Dialysis Facility billing tips page.
Cost Information
