What drugs are separately billable End Stage Renal Disease (ESRD) items and services?
There are other drugs that are not covered under the composite rate, but that may be medically necessary for some patients receiving dialysis. When furnished in the dialysis facility, these items must be billed separately and be accompanied by medical justification either through information on the claims form or as requested by the intermediary. They include: • Antibiotics • Analgesics • Anabolics • Hematinics • Muscle relaxants • Sedatives • Tranquilizers • Thrombolytics: used to declot central venous catheters. References: • CMS Publication 100-02, Chapter 11, section 30.4.2 CMS Publication 100-4, Chapter 8, section 60.2.1.1 Date Posted: 11/29/2007, Date Revised: 03/04/2011 Go to Top • When a medication is ordered and mixed, but it is not administered to the patient due to a change in patient status or a no-show by the patient for that day’s visit, can the hospital bill for the drug? No, payment cannot be made by the Medicare program in this situation. Administration of the drug is
