Section 337.03 - Rate(s) Determination(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 |
Adopted by Mass Register Issue 1328, eff. 12/16/2016.Amended by Mass Register Issue 1449, eff. 8/6/2021.Amended by Mass Register Issue 1518, eff. 3/29/2024.Amended by Mass Register Issue 1520, eff. 3/29/2024.