CurrentMississippi Division of MedicaidPolicy N/A

Dialysis Services (ESRD) Coverage and Provider Requirements

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Rules governing coverage, reimbursement, provider enrollment, documentation, and professional services for outpatient dialysis and ESRD services under Mississippi Medicaid; applies to freestanding and hospital-based kidney dialysis centers and providers serving Mississippi Medicaid beneficiaries.

Policy Summary

PayerMississippi Division of Medicaid

PolicyDialysis Services (ESRD) Coverage and Provider Requirements

Policy CodePolicy N/A

Change TypeNo material change

Effective DateAug 1, 2026

Last ReviewJul 1, 2021

Next Review DateN/A

Key ActionMaintain auditable clinical documentation including dates of service, monthly face-to-face physician evaluations, treatment notes, and legible signatures with credentials.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

4Dialysis modalities covered

monthlyMin. physician visit frequency

bundled ESRD PPSPayment model

none

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CurrentMississippi Division of MedicaidPolicy N/A

Dialysis Services (ESRD) Coverage and Provider Requirements

Customize your policy alerts

Sign up for all Mississippi Division of Medicaid policy alerts

Know when Mississippi Division of Medicaid releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerMississippi Division of Medicaid

PolicyDialysis Services (ESRD) Coverage and Provider Requirements

Policy CodePolicy N/A

Change TypeNo material change

Effective DateAug 1, 2026

Last ReviewJul 1, 2021

Next Review DateN/A

Key ActionMaintain auditable clinical documentation including dates of service, monthly face-to-face physician evaluations, treatment notes, and legible signatures with credentials.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

4Dialysis modalities covered

monthlyMin. physician visit frequency

bundled ESRD PPSPayment model

none

Coverage Criteria for Dialysis and ESRD Services

Covered services and payment structure

Covered when services meet program requirements and are medically necessary as documented:

Covered services list: Hemodialysis; Peritoneal dialysis; Continuous Ambulatory Peritoneal Dialysis (CAPD); Continuous Cyclic Peritoneal Dialysis (CCPD).

From Rule 1.2

Bundled ESRD PPS coverage: All resources used in providing outpatient dialysis services (supplies, equipment, drugs, biologicals, laboratory tests, and support services) are covered under the bundled ESRD PPS rate; facilities must furnish necessary services and bill appropriate revenue codes.

From Rule 1.3

Professional services coverage: Related physician services billed with appropriate procedure codes that are excluded from the ESRD PPS rate are covered; physicians or qualified health care professionals must provide at least one face-to-face visit monthly and document medical necessity for any additional visits. Documentation must be legibly written, signed and dated during the face-to-face visit. Face-to-face visit requirement cannot be met by interdisciplinary team documentation.1 face-to-face visit per month (minimum)

From Rule 1.4

Physician services are not payable under the dialysis facility’s provider number. Related physician services must be billed separately by the physician or qualified health care professional using the appropriate professional procedure codes that are excluded from the ESRD PPS rate. Facilities should not submit physician professional services on the facility’s billing number.

Evaluation and management services that are unrelated to dialysis care must not be performed and billed during the dialysis treatment session. Such non-dialysis E/M services must be provided at a separate encounter and reported separately by the furnishing provider; they cannot be bundled into or claimed as part of the dialysis session.

Dialysis services will not be reimbursed unless there are corresponding treatment notes documenting the service. Facilities must maintain treatment documentation for each dialysis encounter to support billing under the ESRD PPS rate; absence of such notes is a basis for nonpayment.

Coding, Payment, and Visit Frequency

Revenue/prospective paymentmixed

No codes listed

Physician services excluded from ESRD PPSmixed

No codes listed

inv-07: Face-to-face visit frequency — 1 visit per month (minimum).

Minimum frequencyOne (1) face-to-face visit with the beneficiary per month (minimum)

Additional visitsMedical record must document medical necessity for any additional face-to-face visits

Documentation requirementsDocumentation must be legibly written, signed and dated during the face-to-face visit

Interdisciplinary team notesDocumentation by the interdisciplinary team cannot substitute for the physician/qualified health care professional's face-to-face visit

Provider Actions, Documentation, and Billing Rules

Prior Authorization

No prior authorization required

Prior authorization is not required for dialysis services.

Documentation Required

Provider documentation responsibility

Providers must ensure auditable records and physician/qualified healthcare professional documentation are complete and maintained as required; include dates of service, monthly face-to-face evaluations, mode of dialysis and treatment plan, all treatments/medications/labs, and legible signature with credentials and date.

Maintain auditable medical records that substantiate dialysis services.
Physician/QHP documentation must include: dates of service; monthly face-to-face evaluation of current health status and appropriateness of treatment; mode of dialysis and treatment plan; all treatments, medications, biologicals, lab tests and other studies (included and excluded from ESRD PPS); legible signature with credentials and date.

Background

End-stage renal disease (ESRD) requires ongoing renal replacement therapy and may be treated with facility-based or home modalities. Covered modalities include hemodialysis and peritoneal dialysis (including CAPD and CCPD). Dialysis care is provided under a bundled ESRD prospective payment system that covers supplies, equipment, drugs, laboratory services, and support services, and it requires coordinated interdisciplinary care with regular physician oversight. Physicians or qualified health care professionals must perform at least one face-to-face visit monthly and document medical necessity for any additional visits; documentation must be legible, signed and dated.

Definitions

inv-14: CAPD / CCPD — Definitions of Continuous Ambulatory Peritoneal Dialysis and Continuous Cyclic Peritoneal Dialysis.

CAPDContinuous Ambulatory Peritoneal Dialysis (CAPD) — a peritoneal dialysis modality covered by the Division of Medicaid

CCPDContinuous Cyclic Peritoneal Dialysis (CCPD) — a peritoneal dialysis modality covered by the Division of Medicaid

Coverage noteBoth CAPD and CCPD are listed among covered dialysis services under Rule 1.2

Documentation Required

Facility record requirements

Dialysis facility records must include dates of service; a current annual physician evaluation with pertinent labs/diagnostics; individualized treatment notes verifying each face-to-face physician visit; beneficiary assessment per 42 CFR § 494.80; written plan of care reviewed monthly by the interdisciplinary team; mode of dialysis and treatment plan; all treatments/medications/labs; and legible signatures with credentials and date.

Dates of service
Current annual evaluation (age/gender-appropriate history & physical) documented by a physician including pertinent labs/diagnostic procedures
Individualized treatment notes verifying each face-to-face physician visit
Beneficiary assessment in accordance with 42 CFR § 494.80
Written plan of care prepared and reviewed monthly by interdisciplinary team
Mode of dialysis and treatment plan
All treatments, medications, biologicals, lab tests and other studies (included and excluded in the ESRD PPS)
Legible signature of physician or healthcare professional with credentials and date