Reimbursement Policy: Dialysis Routine Service and Supplies

Effective June 1, 2023, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will apply revisions to the Reimbursement Policy "Bundling Guidelines" to include Dialysis Routine Services and Supplies.

The Centers for Medicare and Medicaid Services (CMS) has a list of supplies, labs, and drugs that are bundled into the dialysis payment and are updated annually. These services are included in the per diem payment for dialysis and will not be separately reimbursed.

Similar to CMS, drugs eligible for Transitional Drug Add-on Payment Adjustment (TDAPA) status can be paid separately outside of the dialysis bundle when appended with AX modifier. For more information you can reference the full commercial reimbursement policy and MA reimbursement policy.

This communication applies to State Health Plan (SHP), Federal Employee Program (FEP), Administrative Services Only (ASO), Fully Insured, and Blue Card host claims. It does not apply to Blue Card home claims.