Direct patient care services related to Monthly Capitation Payments (MCP) for End Stage Renal Disease (ESRD) patients are submitted with a single HCPCS code per month, by the physician or non-physician practitioner (NPP) that has primary responsibility for managing the patient's ESRD, using the appropriate code for the patient's age and the number of face-to-face visits for the month.
|
Patient Age
|
Number of Visits per Month
|
HCPCS Code
(Dates of Service Prior to 1/1/09)
|
CPT Code
(Dates of Service on or after 1/1/09)
|
|
Under 2
|
4 or more
|
G0308
|
90951
|
|
2 – 3
|
G0309
|
90952
|
|
1
|
G0310
|
90953
|
|
Ages 2 – 11
|
4 or more
|
G0311
|
90954
|
|
2 – 3
|
G0312
|
90955
|
|
1
|
G0313
|
90956
|
|
Ages 12 – 19
|
4 or more
|
G0314
|
90957
|
|
2 – 3
|
G0315
|
90958
|
|
1
|
G0316
|
90959
|
|
Ages 20 and over
|
4 or more
|
G0317
|
90960
|
|
2 – 3
|
G0318
|
90961
|
|
1
|
G0319
|
90962
|
Documentation and Claim Submission:
- MCP services require documentation of a complete assessment. The plan of care must be established (for new patients) or updated as needed (for established patients).
- Non-physician practitioners (NPPs) are permitted to perform these services based on their scope of practice, as defined by Ohio and West Virginia state law
Resources
- Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims, Pub. 100-04, Chapter 8 (PDF, 625 KB)
- Laboratory Services, Pub. 100-04, Chapter 16 (PDF, 462 KB)
- End Stage Renal Disease Information, Pub. 100-02, Chapter 11 (PDF, 348 KB)
- Physicians' Guide to Medicare Coverage of Kidney Dialysis and Kidney Transplant Services (PDF, 1.65 MB)