About this policy
CMS National Coverage Determination | ncd_id=197 | manual_section=230.13 | coverage_level_code=3 | national_coverage_type=True | under_review=False | lab_ncd=False
Coverage indications
Based upon advice of our medical consultants, we have determined that the Peridex CAPD Filter Set cannot be covered at this time by Medicare because it has not yet been shown to be safe and effective in preventing peritonitis.
Documentation requirements
Item/Service Description: The Peridex Filter Set is used by home continuous ambulatory peritoneal dialysis (CAPD) patients. The Peridex Filter Set is designed to provide sterile filtration during infusion of the dialysis solution in a beneficiary's peritoneal cavity; included in the filter set is a bacterial filter designed to block peritonitis-causing organisms and thus reduce the incidence of peritonitis. Revision History: 05/1989 - Re-categorized dialysis equipment from DME to Home Dialysis Supplies and Equipment for coverage purposes. Effective date NA. (TN 36) Benefit Categories: 29 - Home Dialysis Supplies and Equipment Transmittal: transmittal_number=36 | transmittal_issue_date=1989-05-01
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
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