TMPPM 2008 > Texas Medicaid Services > Renal Dialysis Facility > Benefits and Limitations

   
 

40.3.4.3 Continuous Ambulatory Peritoneal Dialysis

The following laboratory tests are routine for home maintenance CAPD clients when performed according to the indicated frequency. When the client is dialyzing in the home and is not undergoing IPD or hemodialysis in the facility, payment may be made. The provider must indicate the client's diagnosis and the type of dialysis on the claim form. Tests in excess of this frequency or tests not listed in the tables, require documentation of medical necessity for payment to be made.

Every Month

Procedure Codes

5/I-82040

5/I-82310

5/I-82374

5/I-82565

5/I-83615

5/I-83735

5/I-84075

5/I-84100

5/I-84132

5/I-84155

5-84156

5-84157

5/I-84160

5/I-84295

5/I-84450

5/I-84520

5-85018

Every Three Months

Procedure Codes

5-85004

5-85007

5-85008

5-85014

5-85027

5-85041

Every Six Months

Procedure Codes

4/I/T-71010

4/I/T-71015

4/I/T-71020

4/I/T-78300

4/I/T-78305

4/I/T-78306

5-80069

5-81020

5/I/T-95900

5/T-93005


Texas Medicaid & Healthcare Partnership
CPT only copyright 2007 American Medical Association. All rights reserved.
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