Renal Dialysis

PrimeWest Health follows Centers for Medicare & Medicaid Services (CMS) guidelines for End-Stage Renal Dialysis and Acute Kidney Injury (AKI) submission.  

Renal Dialysis Services 

Renal dialysis services are all items and services used to furnish outpatient maintenance dialysis to people for the treatment of End-Stage Renal Disease (ESRD) in the ESRD facility or in a members home. 

Renal dialysis services include but are not limited to the following: 

1. All items and services included under the composite rate as of December 31, 2010
2. Erythropoiesis stimulating agents (ESAs) and their oral or other forms of administration 
3. Injectable drugs and biologicals and their oral or other forms of administration 
4. Oral or other forms of non-injectable drugs and biologicals 
5. Diagnostic laboratory tests 
6. Home and self-dialysis training 
7. All supplies, equipment, and support services necessary for the effective performance of a member’s dialysis furnished in the ESRD facility or in a member’s home

All ESRD related services and supplies are paid to the ESRD facility through the ESRD prospective payment system following CMS guidelines.