Or. Admin. R. 410-125-0201 - Independent ESRD Facilities
(1)
Independent End Stage Renal Dialysis (ESRD) Facilities:
(a) ESRD Facilities are reimbursed for
Continuous Ambulatory Peritoneal Dialysis.
(b) (CAPD), Continuous Cycling Peritoneal
Dialysis (CCPD), and Hemodialysis:
(A)
Composite at 80% of the Medicare allowed amount, except for Epoetin.
(B) Epoetin is reimbursed at 100% of the
Medicare maximum allowed amount.
(2) Other dialysis related charges which are
allowed by Medicare, are reimbursed at 80% of the Medicare maximum allowed
amount. Allowable clinical laboratory charges are reimbursed according to the
Division fee schedule. Billed charges may not exceed the Medicare maximum
allowable amount.
(3) The Division
follows Medicare's criteria for coverage of Epoetin, Intradialytic Parenteral
Nutrition services, and the frequency schedule for laboratory tests for ESRD
services. When laboratory tests are performed at a frequency greater than
specified by Medicare, the additional tests must be billed separately, and are
covered by the Division only if the tests are medically justified by
accompanying documentation. A diagnosis of ESRD alone is not sufficient medical
evidence to warrant coverage of the additional tests.
Notes
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 414.065
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(1) Independent End Stage Renal Dialysis (ESRD) Facilities:
(a) ESRD Facilities are reimbursed for Continuous Ambulatory Peritoneal Dialysis.
(b) (CAPD), Continuous Cycling Peritoneal Dialysis (CCPD), and Hemodialysis:
(A) Composite at 80% of the Medicare allowed amount, except for Epoetin.
(B) Epoetin is reimbursed at 100% of the Medicare maximum allowed amount.
(2) Other dialysis related charges which are allowed by Medicare, are reimbursed at 80% of the Medicare maximum allowed amount. Allowable clinical laboratory charges are reimbursed according to the Division fee schedule. Billed charges may not exceed the Medicare maximum allowable amount.
(3) The Division follows Medicare's criteria for coverage of Epoetin, Intradialytic Parenteral Nutrition services, and the frequency schedule for laboratory tests for ESRD services. When laboratory tests are performed at a frequency greater than specified by Medicare, the additional tests must be billed separately, and are covered by the Division only if the tests are medically justified by accompanying documentation. A diagnosis of ESRD alone is not sufficient medical evidence to warrant coverage of the additional tests.
Notes
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 414.065