Commericial Payers and Home Periotneal Dialysis

How do most commercial payers pay for home peritoneal dialysis?
And what codes do we use on a daily basis? Rev vs CPT?


I talked with a billing person and she said that they use the same form (UB-92) and billing codes for commercial billers that they do for Medicare. They use the 1500 claim form to bill Medicaid. She said they bill their commercial rate and the commercial payers pay what they are going to pay.

I’ve heard that clinics are paid an average of $350 per in-center HD treatment by commercial payers (some pay more; some pay less) in addition to payments for medications and ancillary charges which clinics bill at higher than Medicare rates. Commercial payers may not have the same limitations on what you can and can’t bill as Medicare. For instance, even though Medicare won’t allow a clinic to bill separately for antibiotics for infection under the composite rate, a commercial payer would probably pay the clinic if it provides an antibiotic for peritonitis. If not, the patient should be able to take the doctor’s prescription to his/her pharmacy and get it there if he/she has medication coverage.

Look in the A codes and you will find A4722-A4726 i think for the daily amoount of fluid the patient is using. E1510 should be for the machine. I hope this helps some.