ESRD PPS facility-level adjustments include the following:
An adjustment that reflects urban and rural differences in area wage levels using an area wage index developed from Core-Based Statistical Areas (CBSA).
An adjustment for facilities that furnish a low volume of dialysis treatments. To receive the low-volume adjustment, the facility must submit an attestation to the Medicare Administrative Contractor (MAC) no later than November 1, prior to the calendar year (CY) in which the adjustment would be effective.
A payment adjustment for ESRD facilities located in rural areas.
Note: Claims for pediatric patients are not eligible for the low-volume or rural adjustments.
Certified training facilities receive the wage adjusted training add-on payment to account for nursing time for each training treatment that is furnished. This adjustment applies to both peritoneal dialysis (PD) and hemodialysis (HD) training treatments.