100-02 Medicare Benefit Policy Manual: Chapter 11 Crosswalk

Medicare Benefit Policy Manual
Chapter 11 - End Stage Renal Disease (ESRD)
Crosswalk
New.
Chap.
New
Sect.
Int.
Pub. 13
Carrier
Pub. 13
RDF
Pub. 29
PMs 	Other 	Description
11 	10 	A3-3165,
A3-3166.1,
B3-2230.1,
B3-2231,
RDF-245.10
RDF-240
PR 1-2703,
HO-238
Definitions Relating to ESRD
11 	20 	A3-3167 	B3-2230.2 	RDF-202,
RDF-317.1
PM AB-03-001 	SOM-2272 	Coverage of Outpatient Maintenance Dialysis
11 	20.1 	PM AB-03-01,
PM AB-01-129
Noninvasive Vascular Studies for End Stage
Renal Disease (ESRD) Patients
11 	30 	A3-3166 	B3-2234 	PR 1-2702,
PR 1-2710,
PR 1 2710.4
Payment for Outpatient Maintenance Dialysis
11 	30.1 	A3-3112.6,
A3-3166.2
Frequency of Dialysis Sessions
11 	30.2 	A3-3167.1 	RDF-207.1, 	PR 1-2710.1 	Laboratory Services Included Under Composite Rate
11 	30.2.1 	A3-3167.3 	RDF-207.3 	Laboratory Tests for Hemodialysis, Intermittent
Peritoneal Dialysis (IPD), Continuous Cycling
Peritoneal Dialysis (CCPD) and Hemofiltration
11 	30.2.2 	A-03-033 	Automated Multi-Channel Chemistry (AMCC)
Tests
11 	30.3 	PR 1-2720 	Processing Requests for Composite Rate Exception
11 	30.4 	A3-3168 	B3-2231.3 	Drugs and Biologicals

New.
Chap.
New
Sect.
Int.
Pub. 13
Carrier
Pub. 13
RDF
Pub. 29
PMs 	Other 	Description
11 	30.4.1 	A3-3168A 	RDF-319.1 	PR 1-2710.2 	Drugs Covered Under the Composite Rate
11 	30.4.2 	A3-3168B,
A3-3644E
RDF-319.4 	PR 1-2711.2 	Separately Billable Drugs
11 	30.4.2.1 	A3-3644E 	B3-4461 	RDF-319.4 	Intravenous Iron Therapy
11 	30.4.2.2 	PM AB-02-165 	Levocarnitime for Treatment of Carnitine
Deficiency in ESRD Patients
11 	40 	A3-3169.2 	RDF-318 	PR 1-2740.2 	Beneficiary Selection Form (CMS-382) for Home
Dialysis Patients
11 	40.1 	A3-3169 	RDF-245 	PR 1-2740 	Method I and Method II Reimbursement for Patients
Dialyzing at Home
11 	40.2 	A3-3169.1 	Items and Services Included Under the Composite
Rate for Method I Home Dialysis Patients
11 	50 	A3-3170 	RDF-208 	PR 1-2740.1 	Home Dialysis
11 	50.1 	A3-3170.1 	RDF-60.1 	Installation and Delivery of Home Dialysis Equipment
11 	50.2 	A3-3170.2 	RDF-210 	Current Use of Equipment
11 	50.3 	A3-3170.3 	RDF-209,
RDF-216.1
Other Requirements For Coverage of Home Dialysis
Equipment
11 	50.4 	A3-3170.4 	Home Dialysis Equipment Provided To Home
Hemodialysis and Peritoneal Dialysis Patients
11 	50.5 	A3-3170.5 	RDF-215,
RDF-216.2
Coverage of Home Dialysis Supplies
11 	50.6 	A3-3170.6 	PR 1-2740.1B 	Coverage of Home Dialysis Support Services

New.
Chap.
New
Sect.
Int.
Pub. 13
Carrier
Pub. 13
RDF
Pub. 29
PMs 	Other 	Description
11 	50.6.1 	PASS Merritt004 	Home Health and Hospice Benefits Available for
ESRD Beneficiaries
11 	50.6.1.1 	Coverage Under the Home Health Benefit
11 	50.6.1.2 	Coverage For Surgical Dressings
11 	50.6.1.3 	Distinction Between Dialysis Related and Renal
Related Services
11 	50.6.1.4 	Coverage Under the Hospice Benefit
11 	50.7 	Water Purification and Softening Systems and
Ultrafiltration Monitor
11 	50.8 	A3-3169.3 	PR 1-2713.2 	Coverage of Infacility Dialysis Sessions Furnished to
Home Patients Who Are Traveling
11 	50.9 	A3-3168C 	Antibiotics Furnished to Method II Patients
11 	60 	PR 1-2725.5
(General)
Training
11 	60.1 	A3-3172.1 	PR 1-2707,
PR 1-2725.5.6.6
Hemodialysis Training
11 	60.2 	A3-3172.2,
A3-3112.6D
Intermittent Peritoneal Dialysis Training (IPD)
11 	60.3 	A3-3172.3 	B3-2231.2 	HO-238 	Continuous Ambulatory Peritoneal Dialysis (CAPD)
Training
11 	60.4 	A3-3172.4 	Continuous Cycling Peritoneal Dialysis (CCPD)
Training
11 	70 	Continuous Ambulatory Peritoneal Dialysis

New.
Chap.
New
Sect.
Int.
Pub. 13
Carrier
Pub. 13
RDF
Pub. 29
PMs 	Other 	Description
11 	70.1 	A3-3171.1 	B3-2231.1 	RDF-240.1 	Certification of Facilities Furnishing CAPD Services
11 	70.2 	A3-3171.2 	B3-2231.2 	RDF-240.2 	HO-238.2 	Institutional Dialysis Services Furnished to CAPD
Patients
11 	70.3 	A3-3171.3 	B3-2231.3 	RDF-240.3 	CIM 55-2,
HO-238.3
Support Services and Supplies Furnished to Home
CAPD Patients
11 	80 	B3-2230.3 	Physician's Services for Renal Dialysis Patients -
General
11 	80.1 	B3-2230.4 	Physician's Services to an ESRD Inpatient
11 	80.2 	A3-3172.5 	B3-2230.5,
B3-2231.4
Physician's Services - Outpatient Maintenance
Dialysis
11 	80.3 	A3-3172.5 	B3-2230.6 	Physician's Services During Self-Dialysis Training
11 	80.4 	A3-3178.10 	PR 1-2771.2,
and 2771.2
Physicians' Services for Kidney Transplants
11 	90 	A3-3168D 	B3-4273 	RDF-207.5 	PR 1-2710.3 	Epoetin (EPO)
11 	100 	A3-3174 	Hemofiltration
11 	110 	A3-3175 	Hemoperfusion
11 	120 	B3-4210.3 	PM-AB-01-129 	Skilled Nursing Facility (SNF) Patients Needing
Dialysis Services
11 	130 	A3-3173,
A3-3173.1,
A3-3173.2
Inpatient Hospital Dialysis
11 	130.1 	A3-3173.3 	Inpatient Dialysis in Nonparticipating Hospitals

New.
Chap.
New
Sect.
Int.
Pub. 13
Carrier
Pub. 13
RDF
Pub. 29
PMs 	Other 	Description
11 	130.2 	A3-3173.4 	Extended Intermittent Peritoneal Dialysis
11 	130.3 	A3-3173.5 	Services Provided Under An Agreement
11 	130.4 	A3-3173.6 	Services Provided Under An Arrangement
11 	130.5 	A3-3173.7 	Dialysis Services Provided Under Arrangements to
Hospital Inpatients
11 	140 	A3-3178 	RDF-230 	PR 1-2770 	Transplantation
11 	140.1 	A3-3178.1 	RDF-231 	Identifying Candidates for Transplantation
11 	140.2 	A3-3178.2 	RDF-231 	Identifying Suitable Live Donors
11 	140.3 	A3-3178.3 	Pretransplant Outpatient Services
11 	140.4 	A3-3178.4 	Pretransplant Inpatient Services
11 	140.5 	A3-3178.5 	RDF-231 	Living Donor Evaluation, Patient Has Entitlement or
is in Pre-Entitlement Period
11 	140.6 	A3-3178.6 	RDF-233,
RDF-233.2
Kidney Recipient Admitted for Transplant Evaluation
11 	140.7 	A3-3178.7 	RDF-233.3 	Kidney Recipient Evaluated for Transplant During
Inpatient Stay
11 	140.8 	A3-3178.8 	RDF-233.4 	Kidney Recipient Admitted for Transplantation and
Evaluation
11 	140.9 	A3-3178.9 	Post-Transplant Services Provided to Live Donor
11 	140.10 	A3-3178.11 	Coverage After Recipient Has Exhausted Part A
11 	140.11 	A3-3178.12 	Cadaver Kidneys

New.
Chap.
New
Sect.
Int.
Pub. 13
Carrier
Pub. 13
RDF
Pub. 29
PMs 	Other 	Description
11 	140.12 	A3-3178.13 	RDF-232 	Services Involved
11 	140.13 	A3-3178.14 	Tissue Typing Services For Cadaver Kidney
11 	140.14 	A3-3178.15 	Cadaver Excision Yielding Two Kidneys
11 	140.15 	A3-3178.16 	Provider Costs Related To Cadaver Kidney Excisions
11 	140.16 	A3-3178.17 	Noncovered Transplant Related Items and Services
11 	140.17 	A3-3178.18 	Other Covered Services
11 	140.18 	A3-3178.19 	PR 1-2772 	Hospitals that Excise But Do Not Transplant Kidneys