End Stage Renal Disease (ESRD) Billing Help

End Stage Renal Disease (ESRD) facilities may provide services to Medicaid recipients with kidney impairment that appears irreversible and permanent and requires a regular course of dialysis or kidney transplantation to maintain life.

Covered Services
Medicaid provides coverage for the treatment of ESRD in an outpatient hospital or independently operated, Medicare certified ESRD facility. ESRD services, including hemodialysis, peritoneal dialysis, and other miscellaneous dialysis procedures are Medicaid covered benefits without prior authorization.

Medicaid also provides coverage for Intradialytic Parenteral Nutrition (IDPN) and Intraperitoneal Nutrition (IPN) for hemodialysis and Continuous Ambulatory Peritoneal Dialysis (CAPD) recipients who meet all of the
requirements for Parenteral and Enteral Nutrition coverage. The recipient must have a permanently inoperative internal body organ or function. Provider documentation must indicate that the impairment will be of long and indefinite duration.

Prior Authorization Requirements
Medicaid covered services do not require prior authorization except for out-of-state services. If an established recipient in Nevada needs to travel out of state, the provider or the facility must initiate contact and make financial arrangements with the out of state facility before submitting a prior authorization request to First Health Services.

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