Capital Related Assets Adjustment for the Transitional Add-On Payment Adjustment for New and Innovative Equipment and Supplies

Published 08/14/2023

For dates of service beginning January 1, 2022, through December 31, 2023, End Stage Renal Disease (ESRD) facilities can be paid the Capital Related Assets Adjustment (CRA) for Transitional Add-on Payment Adjustment for New and Innovative Equipment and Supplies (TPNIES) for the Tablo System using HCPCS code E1629. This is the only device the Centers for Medicare & Medicaid Services (CMS) has deemed eligible for the CRA for TPNIES at this time. Palmetto GBA will use invoices to determine the CRA for TPNIES allowance in accordance with CMS Change Request 12347.

Each claim must include the following information:

  • HCPCS E1629
  • Description of item being billed as E1629
  • Invoice amount
  • Wholesale amount per item
  • Discount/rebate amount per item (even if bulk discount)
  • CRA for TPNIES CRA for hemodialysis equipment must be billed with revenue code 0823 and modifier AX appended to the HCPCS

Providers should fax their invoices for E1629 to (803) 462–2620. Please be sure to provide the claim identifying information with the invoice fax. Each claim must have an invoice submitted individually.

The Calculation of CRA for TPNIES
Palmetto GBA will calculate a pre-adjusted amount based on the amortized annual allowance for the device (the lifetime of the device in years) and 13 to 14 treatments per month. The annual offset amount established by CMS will be subtracted from the pre-adjusted amount. The difference will then be multiplied by 65 percent at arrive at the adjusted per treatment amount. The CY 2022 average per treatment CRA for TPNES offset amount is $9.50. The CY 2023 average per treatment CRA for TPNIES offset amount is $9.79.

References

  • MM12347 (PDF) — Implementation of the Capital Related Assets (CRA) Adjustment for the Transitional Add-on Payment Adjustment for New and Innovative Equipment and Supplies (TPNIES) Under the End Stage Renal Disease Prospective Payment System (ESRD PPS)
  • MM12499 (PDF) — Implementation of Changes in the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Payment for Dialysis Furnished for Acute Kidney Injury (AKI) in ESRD Facilities for Calendar Year (CY) 2022

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