End stage renal disease (ESRD): Payment for phosphate binders effective January 1
In the calendar year (CY) 2016 ESRD prospective payment system (PPS) final rule, CMS updated regulations to incorporate renal dialysis service drugs and biological products with only an oral form into the ESRD PPS bundled payment starting January 1. Phosphate binders are paid as a renal dialysis service under Medicare Part B effective January 1, 2025.
As a reminder, phosphate binders aren’t separately payable under Medicare Part D when provided for the treatment of ESRD to a Medicare beneficiary receiving dialysis. When a resident of a nursing home receives dialysis, the regulation requires that the ESRD facility must have a written agreement with the nursing home that outlines the responsibility of each entity. The ESRD facility can bill Medicare Part B for renal dialysis services that it furnishes directly or under arrangements, including arrangements it makes with the nursing home.
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