How much can a Method II supplier charge Medicare as a primary payer for PD patients?
If a patient chooses Method II, the supply company must bill the Medicare durable medical equipment regional carrier (DMERC) for PD equipment and supplies. The supply company must accept Medicare assignment. The maximum that a supplier can bill for one month is: • $1,974.45 for APD (CCPD) • $1,490.85 for CAPD See Chapter 8, §90.2.2 of the Medicare Claims Processing Manual. The supplier must have an agreement with a dialysis clinic or other provider to give antibiotics when needed. Under Method II, antibiotics for pertonitis or a catheter infection are included in the cap a supplier can charge. See Chapter 8, §90.5 of the Medicare Claims Processing Manual. Suppliers bill the DMERC on the CMS-1500 claim form using the following codes: • 0832 Peritoneal Dialysis – Home Supplies (this is for little-used Intermittent PD) • 0833 Peritoneal Dialysis – Home Equipment (this is for little-used IPD) • 0842 CAPD – Home Supplies • 0852 CCPD – Home Supplies • 0853 CCPD – Home Equipment See Chapter 8
