Clarification of Payment for ESRD-Related Services Under the Monthly Capitation Payment
In CY 2011 Physician Fee Schedule (PFS) final rule with comment period (75 FR 73295-73296), CMS required monthlycapitation payment (MCP) physicians or practitioners furnish at least one face-to-face patient visit per month for the home dialysis MCP service as described by CPT codes 90963, 90964, 90965, and 90966. Documentation by the MCP physician or practitioner should support at least one face-to-face encounter per month with the home dialysis patient. For required MCP visits for center based patients and home dialysis patients, the MCP physician or practitioner may use other Medicare certified physicians or practitioners to provide some of the visits during the month. Visits must be furnished face-to-face by a physician, clinical nurse specialist, nurse practitioner, or physician’s assistant. The MCP physician or practitioner does not have to be present when these other physicians or practitioners provide visits. The non-MCP physician or practitioner must be a partner, an employee of the same group practice, or an employee of the MCP physician or practitioner. For example, the physician or practitioner furnishing visits under the MCP may be either a W-2 employee or 1099 independent contractor.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: August 05, 2011
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