Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 337.00 - Rates for Dialysis Treatments and Home Dialysis Supplies
Section 337.03 - Rate(s) Determination

Universal Citation: 101 MA Code of Regs 101.337

Current through Register 1531, September 27, 2024

(1) Rates paid to providers will be subject to the following adjustments and limitations.

(a) In a case where the established charge(s) is lower than the dialysis rate(s) and is not based upon an established income-related sliding fee scale for self-payers, the established charge(s) is the rate(s) paid to the provider.

(b) If home training is included as part of a provider's dialysis program, governmental purchasers and purchasers under M.G.L. c. 152 who choose to purchase the service must pay the dialysis rate(s) plus an add-on listed in 101 CMR 337.03(3) under the appropriate service code.

(2) Rates for Dialysis Treatment and Treatment for Acute Kidney Injuries.

Procedure Code

Description

Rate

90999

Unlisted dialysis procedure, inpatient or outpatient (all-inclusive service per dialysis treatment per patient)

$204.94

G0491

Dialysis procedure at a Medicare certified end stage renal disease (ESRD) facility for acute kidney injury without ESRD

$204.94

The all-inclusive rate identified in 101 CMR 337.03(2) covers all services and supplies as defined in 42 CFR § 410.50, with the exception of physician services and applicable procedure codes in 101 CMR 337.03(3).

(3) The following codes and add-ons must be used when the treatment includes these services:

Procedure Code

Description

Rate

90989

Dialysis training, patient, including helper where applicable, any mode, completed course

$20.00

90993

Dialysis training, patient, including helper where applicable, any mode, course not completed, per training session

$20.00

J0604

Cinacalcet, oral, 1 mg (for ESRD on dialysis)

$0.01

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