About this policy
CMS National Coverage Determination | ncd_id=203 | manual_section=230.14 | coverage_level_code=2 | national_coverage_type=True | under_review=False | lab_ncd=False
Coverage indications
Covered Ultrafiltration and ultrafiltration monitoring as a component of hemodialysis has an established and critical role in maintaining the well-being of ESRD patients and is a covered service. The Ultrafiltration Monitor is covered under the Medicare program when it is used to calculate fluid rates for those recipients who present difficult fluid management problems. Determine the medical necessity of this device on a case-by-case basis. Not Covered Ultrafiltration, independent of conventional dialysis, is considered experimental, and technology exclusively designed for this purpose is not covered under Medicare.
Documentation requirements
Item/Service Description: The Ultrafiltration Monitor is designed to reduce the clinical risks of overfiltration and underfiltration during hemodialysis. Overfiltration is the removal of too much fluid from body tissues and underfiltration is removal of too little fluid. Revision History: 5/1989 - 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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