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Code of Federal Regulations (Last Updated: October 10, 2024) |
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Title 42 - Public Health |
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Chapter IV - Centers for Medicare & Medicaid Services, Department of Health and Human Services |
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SubChapter B - Medicare Program |
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Part 413 - Principles of Reasonable Cost Reimbursement; Payment for End-Stage Renal Disease Services; Optional Prospectively Determined Payment Rates for Skilled Nursing Facilities |
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Subpart H - Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs |
§ 413.230 - Determining the per treatment payment amount.
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§ 413.230 Determining the per treatment payment amount.
The per-treatment payment amount is the sum of:
(a) The per treatment base rate established in § 413.220, adjusted for wages as described in § 413.231, and adjusted for facility-level and patient-level characteristics described in §§ 413.232 and 413.235 of this part;
(b) Any outlier payment under § 413.237;
(c) Any training adjustment add-on under § 413.235(c);
(d) Any transitional drug add-on payment adjustment under § 413.234(c); and
(e) Any transitional add-on payment adjustment for new and innovative equipment and supplies under § 413.236(d); and
(f) Any add-on payment adjustment for new renal dialysis drugs or biological products in existing ESRD PPS functional categories after the payment period for the transitional drug add-on payment adjustment has ended, as described in § 413.234(c)(3) and (g).
[75 FR 49200, Aug. 12, 2010, as amended at 84 FR 60803, Nov. 8, 2019; 88 FR 76505, Nov. 6, 2023]