31.3.2 Method II Home Dialysis (Dealing Direct)If the client is working directly with a single supplier to obtain supplies and equipment for home dialysis, the supplier must submit the appropriate procedure codes for the equipment and supplies provided to the client for the home dialysis. The selected supplier cannot be a dialysis facility but must maintain a written agreement with a support dialysis facility to provide backup and support services. The support facility may bill the following revenue codes:
Examples of dialysis support services include, but are not limited to:
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• The routine laboratory services listed in the table in Section 31.3.1, "In-Facility Services and Method I Home Dialysis Services", are included in the support services and are not considered separately for reimbursement. When one of these laboratory tests is required more frequently than the limitation indicated in the table, renal dialysis facility providers should bill the appropriate procedure code with modifier 91 for separate reimbursement. The supply company must bill the appropriate procedure code(s) for the dialysis supplies. The following supplies may be reimbursed:
Supplies, equipment, and support services for clients working with a single supplier to obtain supplies and equipment for home dialysis may be reimbursed separately up to the total monthly allowable amount. If more than one claim for support services is received per month, the additional claims are denied. The denied claims may be appealed with documentation of medical necessity. |
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Changing the connecting tube (administration set).
