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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 : 6.2.6 Maintenance Hemodialysis

The facility composite rate applies when a chronic renal dialysis client receives hemodialysis in an approved renal dialysis facility. Reimbursement is based on the facility’s per-treatment composite rate, as calculated by Medicare. Services included in the facility’s charge are routine laboratory tests, personnel services, equipment, supplies, and other services associated with the treatment.
For hospitals to be reimbursed for maintenance hemodialysis, they must be enrolled as an approved dialysis facility with the appropriate provider identifier. When a client is admitted for hospitalization for no reason other than to receive maintenance renal dialysis, the dialysis services are considered outpatient services and are covered if the hospital has been designated as a CMS certified renal dialysis center.

Texas Medicaid & Healthcare Partnership
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