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2012 Texas Medicaid Provider Procedures Manual

Clinics and Other Outpatient Facility Services Handbook : 6. Renal Dialysis Facility : 6.2 Services, Benefits, Limitations, and Prior Authorization : 6.2.4 Facility Revenue Codes

6.2.4
The following services are a benefit for renal dialysis centers billing under reimbursement methodology I composite rate or II dealing direct.
All services except ultrafiltration (revenue code 881) are restricted to the following diagnosis codes: 5845, 5846, 5847, 5848, 5849, 5851, 5852, 5853, 5854, 5855, 5856, and 5859.
The facility charge must not include the charge for the physician’s routine supervision.

Texas Medicaid & Healthcare Partnership
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