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ESRD PC Pricer

Section 1881 (b)(12) of the Social Security Act, as amended by section 623 of the Medicare Prescription Drug Improvement and Modernization Act of 2003, establishes the End Stage Renal Disease (ESRD) composite rate payment method for most dialysis related services provided by renal dialysis facilities to Medicare beneficiaries with end stage renal disease. 

This PC Pricer software allows users to enter information to predict reimbursement to a renal dialysis facility based on the type of dialysis and various patient characteristics.  It contains the same payment logic used to calculate composite rate payments for type of bill 72x in the Medicare mainframe system.

CY 2008 Physician Fee Schedule (PFS) Final Rule with Comment

CMS-1385-FC (Final Rule and Associated Data Files) -- (On Display November 1, 2007; Published November 27, 2007) – See Provisions Related to Payment for Renal Dialysis Services Furnished By End-Stage Renal Disease (ESRD) Facilities {Current CY 2008 wage index data are on page 66284 of the 11/27/2007 Federal Register notice}

CY 2009 Physician Fee Schedule (PFS) Final Rule with Comment

CMS-1403-FC (Final Rule and Associated Data Files) -- (On Display October 30, 2008; Published November 19, 2008) – See Provisions Related to Payment for Renal Dialysis Services Furnished By End-Stage Renal Disease (ESRD) Facilities {Current CY 2009 wage index data are on page 70163 of the 11/19/2008 Federal Register notice}

See Core-Based Statistical Area (CBSA) Information below. This PC Pricer may be downloaded to a hard drive or network drive.

Note: Printing from this PC Pricer requires the use of a post-script driver.

The CMS 2014 End Stage Renal Disease Prospective Payment System PC PRICER is now available