End-Stage Renal Disease

End-Stage Renal Disease: Medicare Part A Quick Reference Manual

Table of Contents

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ESRD Provider PTAN Number Range: Third through sixth digit

  • 2300–2499; 3500–3799 Hospital-based ESRD
  • 2500–2999 Independent ESRD facility
  • 3300–3399 Children’s Hospital

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FL 04 Type of Bill

  • 072X – where X equals:
  • 1 = one bill – admit through discharge
  • 7 = adjustment to processed claim
  • 8 = void/cancel processed claim

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FL 6 Statement Covers Period

  • From date First date within billing month
  • Through date Last date within billing month

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FL 18-28 Condition Codes

  • 02 Condition is employment-related
  • 04 Information Only Claim – Patient is HMO Enrollee
  • 59 Nonprimary ESRD Facility
  • 70 Self-Administered anemia management drugs including ESA and EPO
  • 71 Full Care in Unit
  • 72 Self Care in Unit
  • 73 Self Care Training for home/self-dialysis (Initial training: 25 hemodialysis or 15 peritoneal/CAPD/CCPD dialysis)
    • Note about initial training sessions allowed:
      • Hemodialysis or IPD: Three training treatments in a single week are allowed for a total duration longer than three months, unless an exception has been received. Total of 25 hemodialysis or 15 IPD training sessions are allowed.
      • CAPD/CCPD: One training session per day with maximum of 15 training sessions
  • 74 Home Dialysis
  • 76 Back up In-Facility dialysis
    • Note: One of the condition code 71 through 76 apply to each ESRD claim.
  • 80 Home Dialysis in SNF (also report condition code 74)
  • 84 Acute Kidney Injury (AKI)
  • 87 Self-care Retraining

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FL 18-28 Condition Codes for Comorbidity (Three acute and three chronic)

  • MA Payer Only – Acute GI bleed; do not bill/system auto-populates when applicable
  • MB Payer Only – Acute Pneumonia (no longer used); do not bill/system auto-populates when applicable
  • MC Payer Only – Acute Pericarditis; do not bill/system auto-populates when applicable
  • MD Payer Only – Chronic Myelodysplastic syndrome; do not bill/system auto-populates when applicable
  • ME Payer Only – Chronic Hereditary hemolytic and sickle cell anemia category; do not bill/system auto- populates when applicable
  • MF Payer Only – Chronic Monoclonal gammopathy; do not bill/system auto-populates when applicable
  • H3 Reoccurrence of GI Bleed comorbid category (MA)
  • H4 Reoccurrence of Pneumonia comorbid category (MB)
  • H5 Reoccurrence of Pericarditis comorbid Category (MC)

Comorbidities: A comorbidity is a specific patient condition that is secondary to the patient's principal diagnosis that necessitates dialysis, yet has a significant, direct effect on resource use during dialysis. When more than one of the comorbidity categories is present on the claim, the claim will be adjusted for the highest paying comorbidity category.

  • To qualify for the comorbidity adjustment there must be adherence to diagnosis coding requirements. ICD-10 diagnosis codes are updated annually as stated in the CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 23, Fee Schedule Administration and Coding Requirements Section 10, are posted on the CMS ICD-10 web page and are effective each October 1st.
  • ICD-10 codes eligible for a comorbidity payment adjustment may be updated quarterly.
  • The most current co-morbidity payment adjustment list and additional information is available on ESRD PPS Patient-Level Adjustments.
  • Chronic Comorbidity: Adjustment may be made for as long as the chronic condition remains applicable to the patient care provided and is reported on the claim.
  • Acute Comorbidity: Eligible for a payment for the first month reported and then for the next three consecutive months, regardless of whether or not the diagnosis code is on the claim after the first month. This adjustment applies for no more than four consecutive months for any reported acute comorbidity category.

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FL 31-34 Occurrence Codes and Date

  • 24 Date Insurance Denied
  • 33 First Day Medicare Coordination Period for ESRD Beneficiary – Must also bill value code 13
  • 36 Inpatient DC date noncovered transplant
  • 37 Inpatient DC date covered transplant
  • 51 Date of Last Kt/V reading taken during billing period – all ESRD claims must include; also report value code D5
    • Note: Not required if value code D5 is reported with value of 8.88 or 9.99
    • In-center hemodialysis: date during the billing period
    • Peritoneal and home hemodialysis: May use date before billing period but must be within four months of claim DOS

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FL 35-36 Occurrence Span Code and Date

  • 74 Noncovered Level of Care/Leave of Absence (typically not required for ESRD)

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FL 39-41 Value Codes and Amounts

  • A8 *Weight (dry) of patient (kilograms)
  • A9 *Height of patient (centimeters)
    • *Note: Report measurements taken during last dialysis session of month.
  • D5 Last Kt/V reading result; Required on all ESRD claims; use with occurrence code 51
    • Note: Not required when reporting value code D5 with a value of 9.99 (no Kt/V reading available) or value 8.88 indicating patient was prescribed/received greater than three hemodialysis treatments per week for a medically justified and documented clinical need.
  • D6 Total number of minutes of dialysis provided during the billing period.
    • Note:  Effective for DOS on/after 1/1/2025.

      • Definition: The number of minutes (rounded to the nearest whole minute) between the beginning of dialysis treatment time (for example, when the start button on the blood pump is pushed) and the end of dialysis treatment time (for example, when the stop button on the blood bump is pushed).

      • Refer to MLN Matters® MM13445: ESRD & Acute Kidney Injury Dialysis: CY 2024 Updates for additional information

  • 06 Medicare Blood Deductible (Not used when deductible pints replaced)
  • 12 Working Aged Bene/Spouse
  • 13 Primary Payment during 30 Month Coordination Period
  • 14 No Fault
  • 15 Workers’ Compensation
  • 16 PHS, or Federal Agency
  • 17 Payer Only – Total outlier from all dialysis lines; do not bill/system auto-populates when applicable
  • 19 Payer Only – Total low volume amount for dialysis lines; do not bill/system auto-populates when applicable
  • 37 Pints of Blood Furnished
  • 38 Blood Deductible Pints
  • 39 Pints of Blood Replaced
  • 41 Black Lung
  • 42 Veterans Affairs
  • 43 Disabled Bene Under Age 65
  • 44 Contractual Agreement
  • 47 Any Liability Insurance
  • 48 Hemoglobin Reading – Report most recent reading prior to start of billing period
    • Note: Must report VC 48 and/or 49
      • report in three positions with a decimal
      • use the right of the delimiter for the third digit
      • report 99.99 if no reading was taken
  • 49 Hematocrit Reading – report most recent reading prior to start of billing period
    • Note: Must report VC 48 and/or 49
      • report in three positions with a decimal
      • use the right of the delimiter for the third digit
      • report 99.99 if no reading was taken
  • 67 Peritoneal Dialysis Hours
  • 68 EPO Units
  • 70 Payer Only – Codes/Interest Amount); do not bill/system auto-populates when applicable
  • 71 Payer Only – Total ESRD Network Funding); do not bill/system auto-populates when applicable
  • 72 Payer Only – ESRD comorbid Factor; do not bill/system auto-populates when applicable
  • 79 Payer Only – Total Medicare Allowed Payment Amount for Outlier Consideration; do not bill/system auto-populates when applicable
  • 91 Charges for Kidney Acquisition (effective 10/1/2021 for 11X TOB)
  • Q8 Payer Only – Total TPAPA amount; do not bill/system auto-populates when applicable
  • QB Payer Only – Total sum of all HDPA bonus amounts; do not bill/system auto-populates when applicable
  • QG Payer Only – Total TPNIES Amount; do not bill/system auto-populates when applicable
  • QK Payer Only – Maryland Waiver Kidney Acquisition Payment (TOB 11X) – do not bill/payer only

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Important Considerations to Review Prior to Billing

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FL 42 Revenue Codes for Dialysis Drugs

Note: For outlier** consideration ESRD facilities are required to report ESRD-related drugs and biologicals, ESRD-related laboratory tests, and ESRD-related supplies that were or would have been separately payable prior to 1/1/2011.

**CMS ESRD PPS Outlier Services

  • 0250 Pharmacy; includes Part D drug equivalent to injectable – NDC required
  • 0270 Medical/Surgical Supplies and Devices (HCPCS A4657 and A4913)
  • 0634 EPO less than 10,000 units
  • 0635 EPO 10,000 units or more
    • Note: Report the number of EPO injections as number of units in FL 46. Report actual total units administered with Value Code 68.
  • 0636 Drugs requiring detailed coding (injectable); enter HCPCS code in FL 44
    • Note: Number of units, reported in FL 46, should equal the number of times the drug was administered according to current CPT/HCPCS code definition. 

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Frequency of Dialysis Sessions by Dialysis Modality and Treatment Setting

Note: The ESRD PPS provides a per treatment unit of payment. The per treatment unit of payment is the same base rate that is paid for all dialysis treatment modalities (whether in-facility or home) furnished by an ESRD facility.

  • The policy allows for three PPS payments per week.
  • For a 30-day month, payment is limited to 13 treatments and for a 31-day month, payment is limited to 14 treatments, with exceptions made for medical justification.
  • ESRD facilities billing for more than 13 or 14 treatments per month must provide medical justification as required by National Government Services, Inc., your MAC in order to receive payment for the additional treatments.
  • Additional treatments provided without meeting the medical justification required must include the modifier CG on the claim line to identify that the facility attests the additional treatment does not meet medical justification requirements. Additional treatments billed without medical justification do not receive payment. Noncovered treatments are not considered in the outlier payment calculation.
  • This policy does not apply to training/retraining treatments.
Service In-Facility Home
Hemodialysis (HD) Three per week Maximum of three per week regardless of frequency
Medicare routinely covers 13 HD sessions in 30 day calendar month or 14 sessions in 31 day
Hemofiltration Three per week Three per week
Ultrafiltration Three per week Maximum of three per week, regardless of frequency
Peritoneal Dialysis (PD) – includes, for example, CAPD and CCPD
  • Typically performed daily
 HD-equivalent sessions HD-equivalent sessions
Intermittent Peritoneal Dialysis (IPD) Three per week HD-equivalent sessions


Note: Regardless of dialysis modality or treatment setting, payment for additional treatments may be made when they are medically justified.

Note: Ultrafiltration is not a substitute for dialysis. Ultrafiltration is used in cases where excess fluid cannot be removed easily during the regular course of hemodialysis. It is commonly done during the first hour or two of hemodialysis on patients who, for example, have refractory edema. When used during a regular course of dialysis, ultrafiltration is included in the facility’s composite rate. Therefore, no additional charge is recognized for pre-dialysis ultrafiltration.

Resource for above chart: CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 11, Section 50 - ESRD Prospective Payment System (PPS) Base Rate, Item A. Per Treatment Unit of Payment

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FL 42 Revenue Codes for Dialysis

  • 082X Hemodialysis
    • 1 Hemodialysis/Composite
    • 5 Support Services
  • 083X Peritoneal Dialysis (PD)
    • 1 Peritoneal/Composite
    • 5 Support Services
  • 084X Continuous Ambulatory Peritoneal Dialysis (CAPD)
    • 1 CAPD/Composite
    • 5 Support Services
    • 9 Other CAPD Dialysis
  • 085X Continuous Cycling Peritoneal Dialysis (CCPD)
    • 1 CCPD/Composite
    • 5 Support Services
  • 088X Ultrafiltration Dialysis
    • 1 Ultrafiltration
    • 9 Hemoperfusion

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FL 42 Additional Revenue Codes

  • 0270 Medical Surgical Supplies – General
  • 030X Laboratory
    • 3 Renal Patient (Home) – LAB/RENAL HOME
    • 4 Non-routine Dialysis – LAB/NR DIALYSIS
  • 031X Laboratory – Pathology services
    • 0 General Classification – PATHOLOGY LAB or (PATH LAB)
    • 1 Cytology – PATHOL/CYTOLOGY
    • 2 Histology – PATHOL/HYSTOL
    • 4 Biopsy – PATHOL/BIOPSY
    • 9 Other – PATHOL/OTHER
  • 0390 Blood Processing (blood products)
  • 0399 Blood Storage and Processing (blood bank fees)
  • 0771 Vaccine Administration

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FL 44 HCPCS/Rates/Modifiers

Note: HCPCS codes are required for all revenue codes except 083X, 084X, 085X, and 088X

  • 90999 Report URR for hemodialysis patients; modifier required
  • J3490 Unclassified drug – use only when no other code is available; eport specific drug in Remarks section of claim
  • G0491 Dialysis procedure at a Medicare certified ESRD facility (for Acute Kidney Injury without ESRD).
    • Note: When applicable, additional HCPCS/CPT codes should be included on the claim.

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FL 44 Modifiers Required for Reduction In ESA (Erythropoietin Stimulating Agent)

Note: Modifiers GS, ED, and EE are not required for DOS on/after 1/1/2020.

Prescribing practitioners should continue to prescribe ESAs in accordance with ESA dosing guidelines and ESRD facilities should continue to report what they furnish.

ESRD facilities must continue to report all necessary information for the ESRD Quality Incentive Program. CMS has in place a monitoring program that studies the trends and behaviors of ESRD facilities under the ESRD PPS and the health outcomes of the beneficiaries who receives their care. CMS will continue to monitor the utilization of ESAs and any changes in the outlier policy to determine if additional MUEs are necessary.

  • GS Dosage of ESA has been reduced and maintained in response to hematocrit or hemoglobin level
    • Note: No longer required for DOS on/after 1/1/2020
  • ED Hematocrit level has exceeded 39.0% (or hemoglobin level has exceeded 13.0 g/dL) for three or more consecutive billing cycles immediately prior to and including the current billing cycle
    • Note: No longer required for DOS on/after 1/1/2020
  • EE Hematocrit level has not exceeded 39.0% (or hemoglobin level has not exceeded 13.0 g/dL) for three or more consecutive billing cycles immediately prior to and including the current billing cycle Hematocrit level exceeds 39 percent
    • Note: No longer required for DOS on/after 1/1/2020
  • Note: Maximum Number of Allowable Administrations per billing cycle (month)
    • EPO: 13 times in 30 days and 14 times in 31 days.
    • Aranesp: 5 times in 30/31days.
    • Peginesatide: 1 time in 30/31days

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FL 44 Modifiers Required for Adequacy of Hemodialysis

Note: One of the G1 through G6 modifiers must be reported with HCPCS code 90999 on at least one hemodialysis revenue code line (revenue code 0820, 0821, 0825 or 0829).

  • G1 Most recent URR of less than 60%
  • G2 Most recent URR of 60% to 64.9%
  • G3 Most recent URR of 65% to 69.9%
  • G4 Most recent URR of 70% to 74.9%
  • G5 Most recent URR of 75% or greater
  • G6 ESRD patient for whom less than seven dialysis sessions have been provided in a month

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FL 44 Modifiers

  • AX Furnished in conjunction with dialysis – TDAPA services (effective 1/1/2018) and TPNIES
  • AY Service not related to treatment of ESRD
  • CG Attestation that hemodialysis treatment in excess of monthly allowed does not meet medical necessity (effective 10/1/2017)
    • Note: Used when billing of hemodialysis treatments for patients with ESRD in excess of the 13 (30 day month) or 14 (31 day month) monthly allowable treatments; applies to Revenue Codes 0821 and 0881; policy is applicable for all condition codes.
  • ET Emergency services; used on outpatient hospital claim (non- ESRD claim) to attest that laboratory test(s) were ordered in conjunction with the emergency services (containing revenue code 045X) to emergency services often span two calendar days
  • KX Medical Policy requirements met for extra session
  • UJ Services provide at night (nocturnal) – typically longer, slower hemodialysis
  • EM Emergency Reserve Supply of EPO (for ESRD benefit only) – only for patient beginning self-administration of ESA at home
  • V8 Dialysis-access related iinfection present (no longer required)
  • V9 No dialysis-access related infection present (no longer required)

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FL 44 Modifiers for Administration Route

  • JA Intravenous administration (ESA)
  • JB Subcutaneous administration (ESA)
  • JE Drug/biological administered via dialysate
  • FL 44 Modifiers for Vascular Access for Hemodialysis
    • Note: Must report at least one modifier V5, V6, or V7 on latest hemodialysis LIDOS.
  • V5 Vascular Catheter (alone or with any other vascular access) even if not being used for hemodialysis
  • V6 Arteriovenous Graft (or other Vascular Access not including a vascular catheter
  • V7 Arteriovenous Fistula Only (in use with two needles)

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FL 44 Drug Amount Discarded Modifier (for single-dose vial or single-use package – not for multiple use vials)

  • JW Modifier Drug Amount Discarded/Not administered to any patient
    • Report discarded billing units on a separate claim line containing a JW modifier for all renal dialysis drugs and biological products from single-dose containers or single-use packaging
    • Do not report discarded amounts of renal dialysis drugs or biological products from multi-use vials
    • All ESRD facility claims for renal dialysis drugs and biological products from a single-dose container or single-use packaging must include either the JW or JZ modifier
    • Refer to MLN Matters® MM13445 ESRD & Acute Kidney Injury Dialysis: CY 2024 Updates

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FL44 Modifier for No Drug Wastage (single-dose vial or single-use package only – not for multiple use vials)

  • JZ Modifier Zero drug amount discarded/not administered to any patient
    • Report JZ modifier on claim line to attest that there is no discarded amount from a renal dialysis drug or biological product from a single-dose container or single-use packaging
    • All ESRD facility claims for renal dialysis drugs and biological products from a single-dose container or single-use packaging must include either the JW or JZ modifier

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FL 45 Service Date

Report the line item date of service for each dialysis session and each separately payable item or service.

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FL 46 Service Units

Note: Typically, number of units, reported in FL 46, should equal the number of times the service was performed according to current CPT/HCPCS code definition.

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FL 67 ICD-10-CM Diagnosis Code

Hospital-based and independent renal facilities must complete this item and it should include a diagnosis of end stage renal disease for patients with ESRD.

Note: ICD-10 code N186 is typically included as one of the diagnosis codes.

AKI claims must include an applicable ICD-10 diagnosis code as per the list available on the CMS website Acute Kidney Injury and ESRD Facilities.

When applicable: Additional diagnosis codes as well as any comorbid ICD-10 codes.

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FL 80 Remarks

Available for use

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FL 18-28 Claim Change Reason Codes (applicable for adjustments) – report in Condition Code Field – report only one on adjustment/cancel claim - choose single reason that best describes adjustment

  • D0 Change in service dates
  • D1 Change in charges
  • D2 Change in revenue/HCPCS code
  • D4 Change in diagnosis/procedure code
  • D7 Change to make Medicare secondary payer
  • D8 Change to make Medicare primary payer
  • D9 Other change (indicate reason in REMARKS field)
  • E0 Change in patient status

Reference: NGS FISS/DDE Provider Online Guide, FISS Reason Codes

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FL 64 Document Control Number

Required on adjustment request

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Frequency of Dialysis Sessions by Dialysis Modality and Treatment Setting

Dialysis Type In-facility Home
Hemodialysis (HD) 3 per week Maximum of 3 per week regardless of frequency
Hemofiltration 3 per week 3 per week
Ultrafiltration 3 per week Maximum of 3 per week regardless of frequency
CAPD/CCPD Dialysis HD equivalent sessions HD equivalent sessions
Intermittent Peritoneal Dialysis (IPD) 3 per week HD-equivalent sessions

 

ESRD facilities furnishing dialysis in-facility or in a patient's home are paid for a maximum of 13 treatments during a 30-day month or 14 treatments during a 31-day month unless there is medical justification for additional treatments.

Reference: CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 11, End Stage Renal Disease (ESRD), Section 50 – ESRD Prospective Payment System (PPS) Base Rate.

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Non-ESRD Facility: Providing services to a Medicare beneficiary with ESRD

ESRD PPS includes certain services that are subject to consolidated billing when provided by a non-ESRD facility.

  • HCPCS code G0257 Unscheduled or emergency dialysis treatment for an ESRD patient in a hospital outpatient department that is not certified as an ESRD facility.
  • AY Modifier Service not related to treatment of ESRD
    • Note: When a provider other than an ESRD facility provides renal dialysis services to an ESRD beneficiary for reasons not related to the treatment of ESRD, the submitted claim must include the AY modifier to allow for separate payment under Medicare. For example, if an ESRD beneficiary also has cancer and has a laboratory test done related to cancer treatment, the laboratory should submit the claim with an AY modifier in order to receive separate payment.
  • Clarification
    • The AY modifier is not required when laboratory services are billed in conjunction with an emergency room visit billed on a hospital outpatient claim.
    • Emergency services spanning two calendar days.
      • Hospital claim must include an emergency room service billed with revenue code 045x on a line item date that differs from the line item date of service for the related laboratory test(s).
        • Include the modifier ET to attest that the laboratory test(s) were ordered in conjunction with the emergency services.
  • Additional information: CMS ESRD Consolidated Billing Website

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Additional Information

Patient with Acute or Chronic Kidney Failure but not Eligible for Medicare

Outpatient dialysis services for a patient with acute kidney failure or chronic kidney failure but not eligible for Medicare under the ESRD provisions at the time services are rendered must be billed by the hospital and cannot be billed by a Medicare certified renal dialysis facility on bill type 72x. The ESRD PPS base rate is not paid.

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Acute Kidney Injury

AKI claims are billed on the 072X type of bill with:

  • Condition code 84
  • Revenue code 082X, 083x, or 088x for the modality of dialysis furnished
  • HCPCS code G0491 (Dialysis procedure at a Medicare certified ESRD facility for AKI without ESRD).
  • AKI claims do not receive payment adjustments for comorbidities, TDAPA, TPNIES or outlier services
  • The ESRD network reduction is not applicable to AKI claims

Additional information on AKI, including ICD-10 diagnosis codes: Acute Kidney Injury and ESRD Facilities.

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Incomplete Treatment

A dialysis treatment is started, when a patient is connected to the machine and a dialyzer and bloodlines are used. However, if the session is not completed for some unforeseen, but valid reason such as a medical emergency when the patient must be rushed to an emergency room, the facility is paid based on the full PPS base rate.

Note: This is a rare occurrence and must be fully documented in the medical record.

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No Show

If a facility sets up in preparation for a dialysis treatment, but the treatment is never started because the patient never arrives, no payment is made. In this case, no service has been furnished to a Medicare beneficiary even though staff time and supplies may have been used. Furthermore, the facility may not bill the patient or the patient’s private insurance for these services.

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Transitional Drug Add-on Payment

Under the ESRD PPS drug designation process, CMS will pay for the new drug or biological using a transitional drug add-on payment adjustment, if the new injectable or intravenous drug or biological is used to treat or manage a condition for which there is not an existing ESRD PPS functional category.

Drugs eligible for the TPAPA must billed with:

  • Revenue code 0636
  • Modifier AX must be appended to the applicable HCPCS code
  • TDAPA claim lines are shown as covered line items but no payment will be included on the line item. The TDAPA is included in the prospective payment amount on the dialysis revenue code lines
  • Payer Only Value code Q8: Captures the total allowable payment for the TDAPA.
    • The ESRD Pricer divides the Q8 amount by the total number of dialysis treatments and the per treatment amount is added to the PPS rate and included in each dialysis line payment.

Additional information on the TDAPA is available on the CMS website: ESRD PPS Transitional Drug Add-on Payment Adjustment.

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Transitional Add-on Payment Adjustment for New and Innovative Equipment and Supplies:

ESRD PPS provides TPNIES for new and innovative renal dialysis equipment and supplies that qualify under the SSA Section 413.236. The TPNIES is paid for two calendar years, beginning on January 1 and ending on December 31. Note that such new and innovative equipment or supply is not considered an outlier service.

Beginning 1/1/2021, there are no equipment or supplies that qualify for the TPNIES. When available, NGS, your MAC, will provide pricing information for equipment and supplies that are paid under the ESRD PPS using the TPNIES.

Items eligible for the TPNIES must billed with:

  • Revenue code 027X
  • Modifier AX must be appended to the applicable HCPCS code
    • Until TPNIES items receive a HCPCS code report:
      • TPNIES supplies with HCPCS A4913 for miscellaneous dialysis supply not otherwise specified
      • TPNIES equipment with HCPCS code E1699 for miscellaneous dialysis equipment not otherwise specified.
  • TPNIES claim lines are shown as covered line items but no payment will be included on the line item. The TPNIES is included in the prospective payment amount on the dialysis revenue code lines.
  • When billing for a TPNIES eligible equipment or supply, the Remarks field on claim must include the following details to allow NGS, your MAC, to consider this information for pricing. Note that NGS may request more information.
    • HCPCS code
    • Description of item
    • Billed amount to Medicare
    • Invoice amount and number of units on invoice
    • Wholesale amount per item
    • Discount/rebate amount per item (even if bulk discount)
  • Payer Only Value code QG captures the total allowable price for the TPNIES
    • The ESRD Pricer calculates the 65 percent of the MAC, NGS, determined price and divides the amount by the total number of dialysis treatments and the per treatment amount is added to the PPS rate and included in each dialysis line payment.

Additional information on the TPNIES is available on the CMS website: ESRD PPS Transitional Add-on Payment Adjustment for New and Innovative Equipment and Supplies (TPNIES).

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Related Content

CMS website:

Revised 8/19/2024