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December 2016 Texas Medicaid Provider Procedures Manual

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

Renal dialysis is a benefit of Texas Medicaid for the following acute renal failure or end stage renal disease (ESRD) diagnosis codes:
All of the services, except for ultrafiltration (revenue code B-881), are diagnosis-restricted to the diagnoses in the above table.
Refer to:
Subsection 9.2.47, “Organ/Tissue Transplants” in the Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook (Vol. 2, Provider Handbooks).
Subsection 3.2.5, “Organ and Tissue Transplant Services” in the Hospital Services Handbook (Vol. 2, Provider Handbooks) for information on organ transplant and facility services.
Dialysis treatments are a benefit for clients in an inpatient or outpatient hospital or a renal dialysis facility according to the guidelines for outpatient maintenance dialysis approved through CMS. Dialysis treatments may also be a benefit in the client’s home. Outpatient dialysis includes:

Texas Medicaid & Healthcare Partnership
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