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.
Assessment for diabetic patient’s diet and caloric intake is included also.
• Prescribing the parameters of intradialytic management including anticoagulant, dialysis blood flow rates and temperature, duration and frequency of treatments, etc.
The monthly capitation payment is limited to once per month, per recipient, per provide
