100-04 Medicare Claims Processing Manual: Chapter 8 Crosswalk

Medicare Claims Processing Manual
Chapter 8 - Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims
Crosswalk
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8 	10 	A3-3166 	RDF-206 	PRM1-2702 	General Description of ESRD Payment
8 	10.1 	A3-3166 	RDF-245,
RDF-245.2
PRM1-2702 	General Description of ESRD Facility
Composite Rates
8 	10.2 	PRM1-2702.1 	Uncompleted Treatments
8 	10.3 	PRM1-2702.1 	No-Shows
8 	10.4 	RDF-112,
RDF-114
Deductible and Coinsurance
8 	10.5 	PRM1-
2702.1C
Outpatient Hospital Services Which
Become Inpatient Hospital Services
8 	10.6 	PRM1-
2706.1E
Amount of Payment
8 	10.7 	RDF-221 	ESRD Services Not Provided Within the
United States
8 	10.8 	RDF-207.4 	Transportation Services
8 	20 	Definitions Related to Calculating
Composite Rate - section heading only
8 	30 	Determination and Publication of
Composite Rate - section heading only

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8 	30.1 	PRM1-2706.1,
PRM1-2704,
PRM1-2706
42 CFR 413.172 	Publication of Composite Rates
8 	30.2 	PRM1-2706.1 	Determining Individual Facility
Composite Rate
8 	30.3 	PRM1-2705 	Transition Period
8 	30.4 	PRM1-2717 	Record Keeping and Reporting
Requirements Under Composite Rate
System
8 	30.5 	PRM1-2728 	Facility Preparation and Intermediary
Review of Cost Reports
8 	30.6 	PRM1-2719 	Issuance of Notice of Program
Reimbursement
8 	40 	PRM1-2720 	Processing Requests for Composite Rate
Exception
8 	50 	A3-3644 	RDF-207.1 	CWF doc 	In-Facility Dialysis Bill Processing
Procedures
8 	50.1 	RDF-207.1 	A-03-33 	Laboratory Services Included In the
Composite Rate
8 	50.2 	A3-3168A 	Drugs and Biologicals Included In the
Composite Rate
8 	50.3 	RDF-320 	Required Information for In-facility
Claims Paid Under the Composite Rate

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8 	50.3.1 	RDF-320.1 	Submitting Corrected Bills
8 	50.4 	A3-3644.2 	Non-Required Items on the Form
CMS-1450 for ESRD Bills
8 	50.5 	A3-3112.6 	IPD in the Facility
8 	50.6 	RDF-
245.2D
In-Facility Back-Up Dialysis
8 	50.6.1 	A3-3644.1,
A3-3171.1
Payment for In-Facility Maintenance
Dialysis Sessions Furnished to
CAPD/CCPD Home Dialysis Patients
8 	50.6.2 	A3-3644.1 	Payment for Hemodialysis Sessions
8 	50.7 	PRM1-2702.2 	Ultrafiltration
8 	50.8 	A3-3112.6D 	HO-E212.1
HO-E212.2,
HO-E212.3,
HO-E212.4
PRM1-2707,
PRM1-2707.1
Training and Retraining
8 	50.9 	A3-3644.5 	RDF-319.3 	Coding for Adequacy of Hemodialysis
8 	60 	PRM1-2711 	Separately Billable ESRD Items and
Services
8 	60.1 	A3-3644.1,
A3-3167.3
B3-4270.2 	RDF-322 	PRM1-2711.1 	Lab Services
8 	60.2 	A3-3644F1-
A3-3644F5
B3-2231 	RDF-319.1 	Drugs Furnished in Dialysis Facilities

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8 	60.2.1 	Billing Procedures for Drugs for
Facilities
8 	60.2.2 	AB-99-63 	Drug Payment Amounts for Facilities
8 	60.2.3 	A3-3644 	AB-02-005 	Use of Additional Codes by Facilities to
Report Drugs
8 	60.2.4 	A3-3644E 	RDF-319.4 	Intravenous Iron Therapy
8 	60.2.4.1 	A3-3644 	Facility Billing Requirements to the
Intermediary
8 	60.2.4.2 	B3-4461.1
B3-4461.2
B3-4461.3
Physician Billing Requirements to the
Carrier
8 	60.3 	A3-3644G1-
A3-3644G3
PRM1-2711.3 	Blood and Blood Services Furnished in
Hospital Based and Independent Dialysis
Facilities
8 	60.4 	A3-3644D1-
D3,
B3-2049.3B1,
B3-2049.5B
RDF-319,
RDF-
207.5A-C,
PRM1-
2710.3A-D
AB-00-76,
A-01-106,
AB 97-2
EPO
8 	60.4.1 	A3-3644 	PRM1-2710.3 	EPO Facility Billing Requirements Using
UB-92/Form CMS-1450
8 	60.4.2 	B3-4273.1 	EPO Supplier Billing Requirements
(Method II) on the Form CMS-1500
8 	60.4.2.1 	B3-4273.1 	Other Information Required on the Form
CMS-1500

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8 	60.4.2.2 	B3-4273.2 	Completion of Subsequent Form
CMS-1500 Claims for EPO
8 	60.4.3 	A3-3644 	Payment Amount
8 	60.4.3.1 	A3-3644 	Payment in Other Settings
8 	60.4.3.2 	A-01-106 	Hospital Outpatient Departments
8 	60.4.4 	B3-4270.1 	Home Patients
8 	60.4.4.1 	B3-4270.1 	Self Administered EPO Supply
8 	60.5 	PRM1-2711.6 	Intradialytic Parenteral/Enteral Nutrition
(IDPN)
8 	60.6 	PRM1-2711.4 	Hepatitis B Vaccine Furnished to ESRD
Patients
8 	70 	A3-3644
A3-3169
B3-4270.1 	PRM1-
2706.1E,
PRM1-2706.2,
RO2 3440.2 	Payment for Home Dialysis
8 	70.1 	B3-4271 	PRM1-2740.2 	Method Selection for Home Dialysis
Payment
8 	70.1.1 	PRM1-
2740.2D
Change in Method
8 	70.2 	PRM1-2740.3 	Prevention of Double Billing Under
Method I and II
8 	70.3 	PRM1-2740.4 	Overpayments

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8 	80 	A3-3644A,
A3-3169,
B3-4270
B3-4271
RDF-318 	PRM1-2710,
PRM1-2710.4,
RO2 3440 	Home Dialysis Method I Billing to the
Intermediary
8 	80.1 	A3-3169.1 	PRM1-2712 	Items and Services Included in the
Composite Rate for Home Dialysis
8 	80.2 	A3-3644 	CWF doc. 	General Intermediary Bill Processing
Procedures for Method I Home Dialysis
Services
8 	80.2.1 	A3-3644.2 	Required Billing Information for Method
I Claims
8 	80.3 	A3-3112.6 	PRM1-2709,
PRM1-
2709.1A,
PRM1-2709.2,
Calculating Intermediary Payment for
Intermittent Peritoneal Dialysis (IPD) for
Method I
8 	80.3.1 	PRM1-
2709.1B
IPD at Home for Method I Claims
Submitted to the Intermediary
8 	80.4 	A3-3644.1 	PRM1-2709.2 	Calculating Payment for Continuous
Ambulatory Peritoneal Dialysis (CAPD)
and Continuous Cycling Peritoneal
Dialysis (CCPD) Under the Composite
rate
8 	90 	A3-3644A,
A3-3644.3
B3-4270,
B3-4271,
B3-4270.1,
B3-4270.2,
B3-4271
PRM1-2740 	RO2 3440C 	Method II Billing

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8 	90.1 	A3-3170.6,
A3-3644.3,
A3-3644.3A-E
B3-2231.3A
&B,
B3-2231,
B3-4270.1,
HO-238.2C
HO-238.3,
HO-238.3A
PRM1-
2709.2A
DMERC Denials for Beneficiary
Submitted Claims Under Method II
8 	90.2 	B3-4270.1,
B3-3045.7
Requirements For Payment by the
DMERC
8 	90.2.1 	B3-4270.1 	Supplier Documentation Required
8 	90.2.2 	B3-4270.1 	DMERC Letter Explaining Requirements
to Method II Supplier
8 	90.3 	B3-3045.7 	B-01-56 	Amount of Payment by the DMERC
8 	90.3.1 	B3-3045.7 	Billing Instructions for Method II to
DMERCs
8 	90.3.2 	B3-4270 	B-01-56 	Home Dialysis Supplies and Equipment
HCPCS Codes Used to Bill the DMERC
8 	90.3.3 	B3-3045.7C 	DMERC Claims Processing Instructions
8 	90.4 	Equipment and Equipment Related
Services Provided to Direct Dealing
Beneficiary
8 	90.5 	A3-3644.3C,
A3-3644.3D
PRM1-2740.1,
PRM1-2743.1
Method II Support Services Billed to the
Intermediary by the Facility
8 	90.5.1 	A3-3644.3E, 	RDF-321 	Billable UB-92 Revenue Codes Under
Method II
8 	90.5.1.1 	A3-3644.3E 	Unbillable UB-92 Revenue Codes Under
Method II

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8 	100 	A3-3169.3 	RDF-245.2E 	PRM1-2713 	RO-2
3440.3,
Dialysis Sessions Furnished to Patients
Who are Traveling
8 	100.1 	PRM1-2713.1 	Traveling Patients Who are Normally In-
facility Dialysis Patients
8 	100.2 	B3-4271.1,
B3-4272
PRM1-2713.2, 	Traveling Patients Who are Normally
Home Dialysis
8 	100.3 	B3-4272.4 	Physician's Services Furnished to a
Dialysis Patient Away from Home or
Usual Facility
8 	110 	A3-3644c1,
A3-3644c3,
PRM1-2706.2 	Reduction in Medicare Program Payment
to Fund ESRD Networks
8 	120 	PRM1-2770 	Renal Transplantation and Related
Services
8 	120.1 	B3-4471 	PRM1-2711.5, 	AB-01-10 	Payment for Immunosuppressive Drugs
Furnished to Transplant Patients
8 	130 	B3-4270 	Physicians and Supplier (non-facility)
Billing for ESRD Services - General
8 	130.1 	B3-4275,
B3-4275.1,
B3-4275.2
PRM1-2715,
PRM1-2715.1,
PRM1-2715.2
Initial Method for Physician's Services to
Maintenance Dialysis Patients

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8 	140 	B3-15060,
B3-15060.1
B3-15060.2
B3-15060.3
B3-15060.4
B3-15060.5
B3-15350
B3-2230.3
B3-2230.6
B3-4272
B3-4272.1,
B3-4272.2
Monthly Capitation Payment Method for
Physicians' Services Furnished to Patients
on Maintenance Dialysis
8 	140.1 	B3-4272.1 	Services Included in Monthly Capitation
Payment
8 	140.2 	B3-4272 	Services Excluded from Monthly
Capitation Payment
8 	140.3 	B3-4272.2 	Data Elements Required on Claim for
Monthly Capitation Payment
8 	140.4 	B3-4272.3 	Controlling Claims Paid Under the
Monthly Capitation Payment Method
8 	140.5 	B3-15060.3 	Determining Monthly Capitation
Payment Amount for Physician's Services
to Maintenance Dialysis Patients
8 	140.5.1 	B3-15060.4 	Temporary Absence Under MCP
8 	150 	B3-15060.5 	Physician's Self-Dialysis Training
Services

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8 	160 	B3-15062.1,
B3-4275
Payment for Physician's Services
Furnished to Dialysis Inpatients
8 	160.1 	B3-15062.1 	Determining Whether Physician Services
Furnished on Day of Dialysis
8 	160.2 	B3-15062.1 	Physicians' Services Furnished on Day of
Dialysis
8 	160.3 	B3-15062.1 	Physicians' Services Furnished on Non-
Dialysis Days
8 	160.4 	B3-15062.1 	Requirements for Payment
8 	170 	B3-15350,
R1810B3
Billing Physician Dialysis Services
(codes 90935 - 90999) and Related
Payment
8 	180 	AB-01-189,
AB-03-001
Non-Invasive Studies for ESRD Patients
- Facility and Physician Services