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31.3 Benefits, Limitations, and Authorization Requirements
Hemodialysis treatments and peritoneal dialysis treatments including intermittent peritoneal dialysis (IPD), continuous ambulatory peritoneal dialysis (CAPD), and continuous cycling peritoneal dialysis (CCPD) are benefits of the CSHCN Services Program for clients in an inpatient hospital setting, an outpatient hospital setting, a renal dialysis facility, or the client's home as appropriate.
Dialysis services may be provided to dialysis clients by one of the following two methods:
• Method I: In-facility services and facility-supported home dialysis. The dialysis facility provides all necessary services, equipment, and support to the dialysis client either in the facility or in the client's home.
•Method II: Home dialysis by working directly with a dialysis supplier and receiving support services from a dialysis facility. A separate supplier provides services and equipment to the dialysis client in the client's home. The client also receives support services from a dialysis facility with whom the supplier maintains a written agreement to provide backup and support services.
The CSHCN Services Program may reimburse outpatient renal dialysis services for the following diagnosis codes:
The following additional services related to renal dialysis are benefits of the CSHCN Services Program:
•Ultrafiltration
•Dialysis training not to exceed 18 days of hemodialysis or peritoneal (IPD, CAPD, or CCPD) training
Note: The facility charge for dialysis services is denied as part of the dialysis training when billed with the same date of service as the dialysis training.
•Related physician services
•Dialysis support services
The installation and repair of home hemodialysis machines is not a benefit.
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