by Jared Staheli
June 17th, 2015
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.