ESRD Core-Based Statistical Areas (CBSAs) Adjustments

Situation:
The Centers of Medicare & Medicare Services (CMS) has identified an error in the FY 2019 ESRD PPS Pricer currently in Production. The FY 2019 ESRD PPS Pricer applicable to dates of service on or after January 1, 2019, contains approximately thirty Core-Based Statistical Areas (CBSAs) with incorrect wage index values, causing some under/overpayments on ESRD Type of Bill (TOB) 72x.

Status
2/27/2019: Medicare Administrative Contractors (MACs) will initiate mass adjustments on impacted ESRD claims within 90 days from the ESRD Pricer implementation on April 1, 2019. The mass adjustment criteria specified is:

  • ESRD 72x TOB
  • Claim Date of Service (DOS) from January 1, 2019 to March 31, 2019
  • Impacted CBSAs

Impacted CBSAs:

 49 - Virginia  28940 - Knoxville, TN  37460 - Panama City, FL
16820 - Charlottesville, VA
24860 - Greenville-Anderson-Mauldin, SC
38940 - Port St. Lucie, FL
44420 - Staunton-Waynesboro, VA
25940 - Hilton Head Island-Bluffton-Beaufort, SC
15980 - Cape Coral-Fort Myers, FL
40220 - Roanoke, VA
2 - Alaska
48424 - West Palm Beach-Boca Raton-Delray Beach, FL
20994 - Elgin, IL
6 - Colorado
41740 - San Diego-Carlsbad, CA
19180 - Danville, IL
45 – Texas
17020 - Chico, CA
23060 - Fort Wayne, IN
39 - Pennsylvania
44700 - Stockton-Lodi, CA
45940 - Trenton, NJ
48700 - Williamsport, PA
31460 - Madera, CA
25540 - Hartford-West Hartford-East Hartford, CT
20700 - East Stroudsburg, PA
36084 - Oakland-Hayward-Berkeley, CA
27500 - Janesville-Beloit, WI
27980 - Kahului-Wailuku-Lahaina, HI
41500 - Salinas, CA

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