Freestanding Kidney Dialysis Facility Billing

Note: Refer to our Dialysis page for benefit details.

TRICARE has removed freestanding kidney dialysis facilities, also called freestanding end stage renal disease (ESRD) facilities, from the corporate services provider list and added these facilities to TRICARE’s authorized institutional provider list.

Freestanding Kidney Dialysis Facility Requirements

To be considered a freestanding kidney dialysis facility, a facility must:

Be Medicare certified,
Meet all Medicare conditions for coverage (refer to Title 42, Code of Federal Regulations, Part 494 for details),
Be classified as a freestanding kidney dialysis facility by Medicare,
Be TRICARE participating, and
Agree to accept TRICARE payment as full payment.

Reimbursement

Freestanding kidney dialysis facilities are reimbursed a single, flat, per-session fee, which covers:

Institutional charges, such as:
- Charges for facility use
- Use of treatment rooms
- General nursing services (to include the services of technicians, nurses, and other staff involved in establishing, monitoring, or discontinuing the dialysis session)
Laboratory services related to a dialysis session
Pharmaceuticals and supplies related to a dialysis session
Dialysis training (Current Procedural Terminology [CPT®] codes 90989 and 90993)

Note: The dialysis training add-on payment cannot be applied to treatment days 1-120. Visit CMS’ ESRD PPS Consolidated Billing page for more information on what cannot be billed for separately.

Billing Requirements

Freestanding kidney dialysis facilities are to use Type of Bill 72X along with CPT code 90999 (for ESRD claims) or G0491 (for acute kidney injury claims) to bill for the facility/institutional component of individual dialysis sessions or use a more appropriate code if the codes/descriptions are subsequently modified.

Refer to TRICARE Reimbursement Manual, Chapter 18, Section 1 for details.