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End Stage Renal Disease (ESRD) Reimbursement for Automated Tests

Several studies by the Medicare Office of Inspector General noted that end stage renal disease (ESRD) services are not being reimbursed correctly.  In response, CMS has issued new policy regarding how automated, multi-channel chemistry (AMCC) tests are to be coded and paid.  This compliance briefing explains the current payment policy and complicated coding that is now required for these tests. As always, please e-mail your questions, comments and suggestions for future newsletters.

Sincerely,

Charles Root, Ph.D.

Current Payment Policy for ESRD AMCC Tests

Dialysis centers are paid a composite monthly rate for ESRD patients. The following AMCC tests are included in the composite rate payment for regular dialysis patients. A slightly different list of tests applies to CAPD patients.

Monthly automated tests included in the composite rate:

  • Albumin;
  • Alkaline Phosphatase;
  • AST;
  • Calcium;
  • Chloride;
  • CO2;

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