Payment for End-Stage Renal Disease (ESRD) Services

  1. Law
  2. CFR 42
  3. Public Health
  4. Centers for Medicare & Medicaid Services, Department of Health and Human Services
  5. Medicare Program
  6. Principles of Reasonable Cost Reimbursement; Payment for End-Stage Renal Disease Services; Prospectively Determined Payment Rates for Skilled Nursing Facilities; Payment for Acute Kidney Injury Dialysis
  7. Payment for End-Stage Renal Disease (ESRD) Services

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Section
413.170

Scope.

Section
413.171

Definitions.

Section
413.172

Principles of prospective payment.

Section
413.174

Prospective rates for hospital-based and independent ESRD facilities.

Section
413.176

Amount of payments.

Section
413.177

Quality incentive program payment.

Section
413.178

ESRD quality incentive program.

Section
413.180

Procedures for requesting exceptions to payment rates.

Section
413.182

Criteria for approval of exception requests.

Section
413.184

Payment exception: Pediatric patient mix.

Section
413.186

Payment exception: Self-dialysis training costs in pediatric facilities.

Section
413.194

Appeals.

Section
413.195

Limitation on Review.

Section
413.196

Notification of changes in rate-setting methodologies and payment rates.

Section
413.198

Recordkeeping and cost reporting requirements for outpatient maintenance dialysis.

Section
413.200

§ 413.200 [Reserved]

Section
413.202

Organ procurement organization (OPO) cost for kidneys sent to foreign countries or transplanted in patients other than Medicare beneficiaries.

Section
413.203

Transplant center costs for organs sent to foreign countries or transplanted in patients other than Medicare beneficiaries.

Section
413.210

Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.

Section
413.215

Basis of payment.

Section
413.217

Items and services included in the ESRD prospective payment system.

Section
413.220

Methodology for calculating the per-treatment base rate under the ESRD prospective payment system effective January 1, 2011.

Section
413.230

Determining the per treatment payment amount.

Section
413.231

Adjustment for wages.

Section
413.232

Low-volume adjustment.

Section
413.233

Rural facility adjustment.

Section
413.234

Drug designation process.

Section
413.235

Patient-level adjustments.

Section
413.236

Transitional add-on payment adjustment for new and innovative equipment and supplies.

Section
413.237

Outliers.

Section
413.239

Transition period.

Section
413.241

Pharmacy arrangements.