Skip to Main Content
Issue Number - Name
0112-MCP (Monthly Capitation Payment) for ESRD (End Stage Renal Disease) receiving 4 or more visits per month
Review Type
Automated
Claim Type
Physician/Non-Physician Practitioner
Region and State
RAC 1-4
All States
Date Approved
09/11/2018

Description

A Monthly Capitation Payment (MCP) is a payment made to physicians for most dialysis-related physician services furnished to Medicare End Stage Renal Disease (ESRD) patients on a monthly basis. The same monthly amount is paid to the physician for each patient supervised regardless of whether the patient dialyzes at home or as an outpatient in an approved ESRD facility. If a home dialysis patient receives dialysis in a dialysis center or other outpatient facility during the month, the MCP physician or practitioner is paid the management fee for the home dialysis patient and cannot bill the ESRD-related service codes for managing center based patients.

Affected Code(s)

HCPCS Codes 90951 - 90962

Applicable Policy References

Social Security Act, Section 1833(e)

CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 8, Sections 140, 140.1 and 140.4

CMS Pub. 100-02, Medicare Benefit Policy, Chapter 11, Section 20

American Medical Association (AMA), Current Procedural Terminology 2015 to current