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MEDICARE
Coverage of Kidney Dialysis and
Kidney Transplant Services
U.S. Department of Health and Human Services (HCFA)
Health Care Financing Administration
Publicaton No. HCFA 10128
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Below is the text version of Medicare's supplement to Your Medicare Handbook relating to dialysis and transplant services. To help you move quickly around this lengthy document, just click on the desired topic of your choice. |
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"Be
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| VICTOR SAYS | ||
Medicare and
Treatment for Permanent Kidney Failure
The Two Parts of Medicare
Hospital
Insurance (Part A)
Medical Insurance
(Part B)
Enrollment
in Medicare for People with Permanent Kidney Failure
When Medicare Protection Begins
When Medicare Protection Ends
Medicare
Payment for Beneficiaries Covered by Employer Group Health Plans
Providers of
Maintenance Dialysis and Transplant Surgery
Coverage of Maintenance Dialysis
Outpatient Dialysis
Inpatient Dialysis
Doctor's Services and
Maintenance Dialysis
Outpatient
Doctor's Services
Inpatient
Doctor's Services
Self-Dialysis Training
Home Dialysis
Payment
Options Under Home Dialysis
Method
I: The Composite Rate
Method
II: Dealing Directly with a Supplier
Home Dialysis
Equipment
Home Dialysis
Supplies
Home Dialysis
Support Services
Kidney Transplant Surgery
What Does Hospital
Insurance (Part A) Cover?
What Does Medical
Insurance (Part B) Cover?
How Medicare Pays for Blood
Other Payment Sources
If You Have a Complaint
For Additional Help
ESRD Network Organizations
MEDICARE AND TREATMENT FOR PERMANENT KIDNEY FAILURE
This supplement to Your Medicare Handbook explains the
special rules that apply to Medicare coverage and payment for maintenance kidney
dialysis and transplant services. People who have permanent kidney failure (End
Stage Renal Disease or ESRD) can get these services.
Medicare also helps pay for a wide range of other health services and supplies. Your
Medicare Handbook describes the other health services and supplies that are
covered by Medicare and how payments are made.
THE TWO PARTS OF MEDICARE
Hospital Insurance (Part
A)
Hospital care Medicare Part A covers medically necessary inpatient hospital
care. Medicare helps pay for up to 90 days of medically necessary inpatient
hospital care in each benefit period. Medicare will help pay for more days if
you use all or some of your lifetime reserve days. (See below for an explanation
of benefit periods and lifetime reserve days.)
From the first day through the 60th day in a hospital during each benefit
period, Part A pays for all covered services except the Part A deductible. From
the 61st through the 90th day in a hospital during each benefit period, Part A
pays for all covered services except for a daily amount called Part A
coinsurance.
Skilled nursing facility care
Under certain conditions, Medicare Part A helps pay for 100 days of
post-hospital care in a skilled nursing facility. You pay no deductible or
coinsurance for the first 20 days, but you do pay a daily coinsurance amount for
days 21 through 100.
Home health care
Medicare Part A helps pay for medically necessary home health care. You pay no
home health care deductible or coinsurance, except for 20 percent of the
approved amount for durable medical equipment.
Hospice care
Medicare Part A helps pay for up to 210 days of hospice care. When
necessary, an extended period of coverage may be allowed. You pay no deductible;
you pay a small coinsurance amount for outpatient drugs and respite care.
Benefit periods
The benefit period is a way of measuring your use of inpatient hospital and
skilled nursing facility services under Medicare Part A.
Your first benefit period starts the first time you enter a hospital after your
hospital insurance begins. A benefit period ends when you have been out of a
hospital or other facility primarily providing skilled nursing or rehabilitation
services for 60 days in a row (including the day of discharge). If you remain in
a facility (other than a hospital) that primarily provides skilled nursing or
rehabilitative services, a benefit period ends when you have not received any
skilled care there for 60 days in a row.
There is no limit to the number of benefit periods you can have for hospital and
skilled nursing facility care.
Reserve days
Medicare Part A includes an extra 60 hospital days you can use if you have a
long illness and have to stay in the hospital for more than 90 days. These extra
days are called reserve days. You have only 60 reserve days in your lifetime,
and you can decide when you want to use them.
Medical Insurance (Part B)
Medicare Part B covers doctor's services, outpatient hospital services,
outpatient physical therapy and speech pathology services, and many other health
services and supplies.
Most of the services and supplies needed by people with permanent kidney failure
are covered by Part B. Part B has premiums, deductibles and coinsurance amounts
that you must pay yourself or through coverage by another insurer.
The first $100 in covered expenses is called the Part B deductible. You need to
meet this $100 deductible only once during the year. The deductible can be met
by any combination of covered expenses.
After you have paid $100 in Medicare-approved charges for covered medical
expenses, Part B generally pays 80 percent of the approved charges for any
additional covered services you receive for the rest of the year. You are
responsible for the remaining 20 percent, your coinsurance.
See below for more information about Medicare Part B payments.
ENROLLMENT
IN MEDICARE FOR PEOPLE WITH PERMANENT KIDNEY FAILURE
You are eligible for Medicare Part A regardless of your age if you require
regular dialysis or have had a kidney transplant, and meet one of the following
requirements:
- You have worked the required amount of time under Social Security, the Railroad Retirement Board, or as a government employee.
- You are receiving or are eligible for Social Security or Railroad Retirement cash benefits.
- You are the spouse or dependent child of a person who has worked the required amount of time or who is receiving Social Security or Railroad Retirement cash benefits.
You can enroll at your local Social Security office. You may
also want to enroll in Medicare Part B when you enroll for Part A.
If you have had Medicare before you developed permanent kidney failure and have
not signed up for Part B or if your Part B has stopped, you can apply for this
protection now. If you already have Part B but are paying a premium penalty for
late enrollment, your premium amount can be reduced to the current basic rate.
Social Security can give you more information.
If you have permanent kidney failure you cannot join a Medicare managed care
plan (HMO). However, if you develop permanent kidney failure after joining a
managed care plan, the plan will provide, pay for
WHEN MEDICARE PROTECTION BEGINS
When you are first enrolled in Medicare because of permanent kidney failure, your Medicare protection starts with the 3rd month after the month your course of maintenance dialysis treatments began. For example, if you began receiving maintenance dialysis treatments in July, your Medicare coverage would start on October 1.
There are two ways your Medicare protection can begin earlier.
Medicare coverage can begin in the first month of dialysis if:
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you participate in a self-dialysis training program in a Medicare-approved training facility;
- you start the training before the third month after dialysis begins, and;
- you expect to complete the training and self-dialyze after that.
- the transplant takes place in that month or within the two following months.
If your transplant is delayed more than two months after you
are admitted to the hospital for the transplant or procedures preliminary to
the transplant, Medicare will begin two months before the month of the
transplant.
WHEN MEDICARE PROTECTION ENDS
If you have Medicare only because of permanent kidney failure,
Medicare protection will end 12 months after the month you no longer require
maintenance dialysis treatments or 36 months after the month of a kidney
transplant.
Note: Medicare coverage may be reinstated immediately without any waiting
period if:
- You resume dialysis or get a transplant within the 12 month period after the month you stopped getting dialysis; or
- You begin or resume dialysis or get another transplant within the 36-month period after a transplant.
Your Medicare Part B can stop at any time if you fail to pay
premiums or if you decide to cancel it.
MEDICARE
PAYMENT FOR BENEFICIARIES COVERED BY EMPLOYER GROUP HEALTH PLANS
Some Medicare beneficiaries are also covered by an employer group health
plan. For these Medicare beneficiaries the employer plan is often the primary
plan--that is, the employer plan pays first on the Medicare beneficiary's health
insurance claims.
If you can get Medicare because of permanent kidney failure and are covered by
an employer group health plan, Medicare will be your secondary payer during a
30-month coordination period. Employer coverage is always primary to Medicare
during the 18-month coordination period. When employer coverage is based on
retirement, it is primary to Medicare during the 30-month coordination period.
The 30-month period in which Medicare is secondary begins the first month you
are able to get Medicare because of permanent kidney disease--whether or not you
are enrolled. The 30-month coordination period also to people already enrolled
in Medicare because of age or disability, and who develop ESRD.
Since you usually cannot get Medicare until the third month after the month in
which you start a regular course of dialysis, you would have only your employer
group health plan coverage during the first 3 months of dialysis-unless you are
already enrolled in Medicare because of age or disability. However, if you
undertake a course in self-dialysis training or receive a kidney transplant
during the 3-month waiting period, part or all of this initial 3-month period
would be included in the 30-month period during which Medicare may be secondary.
Employer plans pay first for kidney treatment and other health services
furnished during the 30-month period. However, if the employer plan doesn't pay
in full, Medicare may make secondary payments to supplement the amount paid by
the employer plan. At the end of the 30-month period, Medicare becomes the
primary payer. If you are covered by an employer group health plan during the
30-month period, you should tell the person who furnishes you with medical
services so that the services can be billed correctly.
If you have more than one period of Medicare enrollment based on kidney disease,
there is a separate coordination period for each period of Medicare enrollment.
For instance, if you receive a kidney transplant which is successful for at
least 36 months, your Medicare protection ends as indicated above under When
Medicare Protection Ends. If after the 36-month period you file for and
again become enrolled in Medicare because you resume maintenance dialysis or
receive another transplant, your Medicare coverage will be reinstated
immediately, without a waiting period, and there will be a new 30-month
coordination period if you are covered by an employer group health plan.
If your employer plan will pay for all your health expenses, you may wish to
wait until the 30-month period is over to file for Medicare Part A and Part B
enrollment. Delay in enrollment avoids making unnecessary Medicare Part B
premium payments. Check with Social Security before you decide to delay
enrollment to make sure the delay is wise in your case.
PROVIDERS OF
MAINTENANCE DIALYSIS AND TRANSPLANT SURGERY
To receive Medicare payments, medical facilities must be specifically
approved to provide maintenance dialysis or kidney transplant surgery-even if
they already participate in Medicare to provide other health care services
covered by the program.
They must meet special health, safety, professional and staffing standards
directly related to dialysis and kidney transplant services. And they must meet
applicable federal, state, and local requirements.
Your doctor or the facility can tell you whether a facility is approved by
Medicare for payment of maintenance dialysis or transplant services.
COVERAGE OF MAINTENANCE DIALYSIS
Outpatient Dialysis
Medicare Part B helps pay for outpatient maintenance dialysis treatments in any
approved dialysis facility. Your coverage includes the costs of equipment,
supplies, certain laboratory tests and other services associated with your
treatment. Part B payments for outpatient maintenance dialysis furnished in the
facility are always made to the facility.
Medicare pays the facility for dialysis-related services based on a per
treatment rate that is set in advance. This rate is the facility's composite
rate. The facility may charge you only 20 percent of this rate. For example,
if you have already met the $100 deductible and the composite rate is $130 per
treatment, Part B pays the facility 80 percent of $130 (or $104). You or your
supplemental insurer pay the remaining 20 percent (or $26) co insurance charge.
In addition to those dialysis-related services included in the composite rate,
dialysis facilities may provide and bill separately for certain other services.
Many of the laboratory tests you get, for example, may be included as part of
the facility's maintenance dialysis services. But, if you need additional tests,
they can be covered as facility services, independent laboratory services, or as
outpatient hospital services. For the services not included in the composite
rate, you are responsible for a 20 percent coinsurance charge.
For more information on covered services, see the sections on doctors services
and outpatient hospital services in Your Medicare Handbook.
Dialysis Patients Who Travel
If you are a dialysis patient and plan to travel, you should make
arrangements for dialysis care along the route of your trip before you
travel away from your usual dialysis facility. You are responsible for ensuring
that an approved dialysis facility along the way has space and time available
for your care, and that the physician and other medical personnel at the
facility have enough information about you to treat you properly. Your facility
will assist you in making the necessary inquiries.
When you plan your trip, take into account the location of Medicare approved
dialysis facilities. There are over 3,000 facilities around the country. Your
facility, ESRD network, or local organization should be able to help you get the
names and addresses of those facilities.
NOTE: If you get your dialysis services either from a Method II supplier or from
a health maintenance organization (HMO), ask your supplier or HMO to assist you
in getting dialysis while on travel. You may be responsible for your own
dialysis treatment costs.
In general, Medicare will pay only for hospital or medical care received in
the United States.
Inpatient Dialysis
Generally, maintenance dialysis treatments are covered on an outpatient
basis. But if you are admitted to a hospital because your medical condition
requires the availability of other specialized hospital services on an inpatient
basis, your maintenance dialysis treatments would be covered by Part A as part
of the costs of your covered inpatient hospital stay. Please see Your
Medicare Handbook for more information about the coverage of inpatient
hospital care.
DOCTOR'S SERVICES AND
MAINTENANCE DIALYSIS
Doctors services are covered by Medicare Part B. While you are on
maintenance dialysis, Part B can pay for your doctor's services in the following
ways.
Outpatient Doctor's Services
Medicare pays benefits for all doctor's services related to outpatient
maintenance dialysis. Medicare carriers pay doctors on a monthly basis for the
kidney disease-related services they provide to each patient. The same monthly
amount is paid for each patient the doctor supervises, regardless of whether the
patient dialyzes at home or as an outpatient in an end-stage renal disease (ESRD)
facility. Using this method of physician payment, Part B pays 80 percent of the
monthly fee, minus any part of the $100 deductible you have not met.
If your doctor accepts assignment, Medicare payment is made directly to him or
her; otherwise, you receive the payment.
Inpatient Doctor's Services
If you are hospitalized, your doctor has a choice of two methods of payment
for furnishing services to you as an inpatient.
- Your doctor may choose to continue to receive the monthly payment, in which case you cannot be billed for any additional amounts.
- Your doctor can choose to bill separately for the inpatient services, which Medicare will pay for in the manner described in Your Medicare Handbook. In this case, your doctor's monthly payment will be reduced based on the number of days you are hospitalized.
Self-dialysis training is covered by Medicare Part B on an outpatient basis.
Coverage of self-dialysis training includes your instruction and instruction for the person who will assist you with maintenance self-dialysis at home. Part B also covers the maintenance dialysis treatment and laboratory tests and other services and supplies associated with the treatment.
By law, Medicare cannot cover the cost of paid dialysis aides to assist self-dialysis patients at home. Nor can Medicare cover the costs of wages that you and your assistant lose while being trained, or the cost of lodging during treatment.
Payment rates for self-dialysis training sessions are higher than those for maintenance dialysis treatments. And charges vary from one dialysis facility to another, depending upon type of facility and its geographic location. But regardless of variations in charges, this is how Medicare payment works: If you are charged $150 per session and have already met the annual deductible, Part B will pay 80 percent of the training rate (or $120 per session). Medicare cannot pay the remaining 20 percent (or $30 per session).
For the services of the doctor who is conducting your self-dialysis training, the maximum total charge
Part B will approve is $500. If you have already met the Part B deductible and your doctor charges you $500, Medicare would pay 80 percent of $500 (or $400). Medicare cannot pay the remaining 20 percent (or $100), or any charges above the Medicare approved amount.
Retraining for self-dialysis-for example, in the use of new equipment is also covered by Medicare Part B on an outpatient basis.
HOME DIALYSIS
Medicare Part B covers home dialysis equipment, all necessary supplies, and a wide range of home support services. Home dialysis includes home hemodialysis, home intermittent peritoneal dialysis (IPD), home continuous cycling peritoneal dialysis (CCPD), and home continuous ambulatory peritoneal dialysis (CAPD).
Usually, drugs used in your home are not covered unless a doctor administers them. However, certain drugs for home dialysis patients are covered even though a doctor is not present. The most common of these are heparin, the antidote for heparin when medically indicated, and topical anesthetics. In addition, Part B covers the self-administration of the drug Epoetin alfa (EPO), by you or your caregiver, subject to standards established for this drug's safe and effective use. Blood or packed red blood cells cannot be covered for home dialysis unless your doctor administers it or personally directs its administration, or if the blood is needed to prime your dialysis equipment (see How Medicare Pays for Blood).
Payment Options Under Home Dialysis
If you dialyze at home, you can choose between two payment options: Method I or Method II. These options are described below. To make a choice, you complete the Beneficiary Selection Form HCFA-382, sign it and return it to the facility supervising your care. You can get a copy of Form-382 from your dialysis facility. Once you make your initial choice, you must continue under that option until December 31 of that year. You can change from one method to the other by filing a new Form-382 at any time, but the change does not go into effect until the following January 1. It is important to remember that choosing Method I or Method II does not in any way prevent you from returning to treatment in a center, selecting another kind of treatment for ESRD care, or choosing to associate with another facility.
Method I: The Composite Rate
If you choose Method I your dialysis facility is responsible for providing all services, equipment and supplies necessary for home dialysis. Medicare pays the facility directly for these items and services at a predetermined composite rate. Under this arrangement, you are responsible for paying the $100 deductible and the 20 percent coinsurance on the Medicare rate to the facility.
Method II: Dealing Directly with a Supplier
If you choose Method II, you must deal directly with a single supplier to obtain all of your home dialysis equipment and supplies. Your supplier must have a written agreement with a dialysis facility to guarantee that you will receive all necessary backup and home dialysis support services. If your supplier does not accept assignment of Medicare benefits (Medicare's allowance for its charges) then Medicare will not pay anything, and you will be responsible for the supplier's entire bill. If your supplier accepts assignment, you are responsible for any unmet part of the $100 deductible and for 20 percent coinsurance of the approved charges for these items and services. There is a national payment limit under Method II, and no supplier may charge more than this limit.
Under both methods, you must receive your home dialysis support services from your facility, for which Medicare pays the facility directly.
Home Dialysis Equipment
Under Method I, all home dialysis equipment and equipment- related services are covered under the facility's composite rate payment. Under Method II, Part B also covers rental or purchase of dialysis equipment for home use. Delivery, installation and maintenance charges are included as part of this benefit.
Whether you rent or buy dialysis equipment, Part B usually makes monthly payments. If you buy dialysis equipment, the monthly Part B payment includes any reasonable interest or carrying charges that may be part of an installment purchase agreement with the supplier of the equipment.
After the $100 deductible, Part B pays 80 percent of the approved monthly rental charge or the approved monthly installment purchase price for your home dialysis equipment.
Medicare Part B payments for your home dialysis equipment can continue as long as you need to be dialyzed at home. If your need for home dialysis stops, Part B payments also stop. For example, if you no longer need to be dialyzed because your kidney transplant surgery was successful, then Part B payments for your home dialysis equipment would stop.
If you purchase your dialysis equipment, Part B payments always stop when the Medicare approved purchase price is reached.
Home Dialysis Supplies
Part B covers all supplies necessary to perform home dialysis. This includes disposable items such as alcohol wipes, sterile drapes and rubber gloves, forceps, scissors, and topical anesthetics. Under Method I, all home dialysis supplies are covered under the facility's composite rate payment. Under Method II, after the $100 deductible, Part B pays 80 percent of the approved charges for all covered items.
Home Dialysis Support Services
Medicare Part B covers periodic support services, furnished by an approved hospital or facility, which are necessary to help you remain on home dialysis. After your doctor approves the plan of treatment, such support services may include visits by trained hospital or facility personnel to periodically monitor your home dialysis and to assist in emergencies when necessary. Part B also covers the services of qualified facility or hospital personnel to inspect your dialysis equipment and to test your water supply.
Under Method I, all home dialysis support services are covered under the facility's composite rate payment. Under Method II, Part B pays directly to the facility 80 percent of the approved charges for all covered services after the $100 deductible has been met.
KIDNEY TRANSPLANT SURGERY
Both parts of Medicare (A & B) help pay for kidney transplant surgery.
What Does Hospital Insurance (Part A) Cover?
Medicare Part A covers your inpatient hospital services in an approved hospital when you are admitted for kidney transplant surgery. (See Medicare inpatient hospital benefit for more information.) Part A also covers hospital services in preparation for your kidney transplant. This includes the Kidney Registry fee and services such as laboratory and other tests that are required to evaluate your medical condition and the medical conditions of potential kidney donors. These preparatory services are covered whether they are done by the approved hospital where your transplant surgery will take place or by another hospital that participates in Medicare. If there is no kidney donor, the costs of obtaining a suitable kidney for your transplant surgery are also covered.
Part A pays the full cost of care for a person who donates a kidney for your transplant surgery. This includes all reasonable preparatory, operation, and postoperative recovery expenses connected with the donation. There is no deductible or daily amount for your donor's hospital stay. The inpatient hospital stay does not qualify your donor for any Medicare benefits not associated with the kidney donation. But, Medicare Part A will pay for any additional inpatient hospital care your donor might need if complications result directly from the kidney donation. Medicare does not pay for kidneys; the purchase of human organs is prohibited by law.
Medicare Part A payments are made directly to the hospital.
What Does Medical Insurance (Part B) Cover?
Medicare Part B covers your surgeon's services for performing the kidney transplant operation. This includes pre-operative care, the surgical procedure, and follow-up care. Part B also covers doctor's services provided to your kidney donor during his or her inpatient hospital stay while you are receiving a kidney transplant.
After you meet the $100 Part B deductible, Part B pays 80 percent of the approved charge for your surgeon's services to you. You are responsible for the remaining 20 percent.
There are certain limits on the amount your doctor can charge you, even if your doctor does not take assignment. On unassigned claims, you are only responsible for the part of your bill that is more than the Medicare-approved amount-up to the limit Medicare allows your doctor to charge. Look in Your Medicare Handbook for more information about "assignment" and limits on charges.
There is no deductible or coinsurance for doctor's services provided to your kidney donor.
Following your discharge from a transplant hospital, Medicare pays for your immunosuppressive drug therapy. As of July 1, 1995, Medicare pays for your immunosuppressive drugs for a period of 36 months following your discharge. This benefit is subject to the Part B deductible and coinsurance provisions.
HOW MEDICARE PAYS FOR BLOOD
Both parts of Medicare can help pay for whole blood or units of packed red blood cells, blood components, and the cost of blood processing and administration after the Part A and B blood deductibles are met.
Medicare Part A does not pay for the first three units of whole blood or units of packed red cells that you receive, during a benefit period, as an inpatient of a hospital or skilled nursing facility. You are responsible for the first three units of whole blood or packed red cells. You have the option of paying the hospital's charges for the blood or packed red cells or arranging for it to be replaced.
If you choose to have the blood replaced, you can arrange for another person or an organization to replace it for you. A hospital or skilled nursing facility cannot charge you for any of the first three pints of blood you have replaced or have arranged to replace. Also, if the provider obtained blood or red cells at no charge other than a processing or service charge, the blood or red cells is deemed to have been replaced.
If you have paid for or replaced some units of blood under Medicare Part B during the calendar year, you do not have to pay for or replace that number of units again under Part A.
Except for replaced whole blood or packed red cells, Medicare Part B does not pay for the first three units of whole blood or units of packed red cells that are furnished in a calendar year.
NOTE: The blood deductible does not apply to other blood components such as platelets, fibrinogen, plasma, gamma globulin, and serum albumin, or to the cost of processing, storing, and administering blood.
After you have met the $100 deductible, Part B pays 80 percent of the approved charges for blood starting with the fourth pint in a calendar year.
Medicare does not cover blood in connection with self-dialysis at home unless it is provided as part of a doctor's service or is needed solely for the purpose of priming the dialysis equipment.
If you have paid for or replaced blood under Medicare Part A during the calendar year, you do not have to do so again under Part B.
WHAT MEDICARE DOES NOT COVER
The following list shows some of the services and supplies that Medicare does not cover in connection with dialysis and transplant services. Your Medicare Handbook lists other services and supplies which are not covered by Medicare (see "What Medicare Does Not Cover").
- Ambulance or other transportation costs to a facility for routine outpatient maintenance dialysis.
- Dialysis aides’ services to assist in home dialysis.
- Inpatient hospital and skilled nursing facility costs when the stay is solely for maintenance dialysis.
- Lodging costs when an outpatient dialysis facility if not near your home.
- Wage losses to you and your dialysis partner during self-dialysis training.
If you have health care protection from private health insurance, the Veterans Administration, the Indian Health Service, a federal employee’s health plan, CHAMPUS, or another source, it also may help pay for services you need for the treatment of permanent kidney failure.
In most states there are agencies that help with some of the medical expenses Medicare does not cover. Some states have Kidney Commissions that assist people in meeting the expenses Medicare cannot pay. And most states have a Medicare program that helps pay medical expenses in cases of serious financial need.
Under certain circumstances, employer group health plans, including federal employee health plans, will be required to pay their benefits before Medicare pays (see Medicare Payment for Beneficiaries Covered by Employer Group Health Plans).
IF YOU HAVE A COMPLAINT
If you have a grievance or complaint about the quality or adequacy of care you are getting, discuss your problem with your doctor, nurse or facility administrator first. If this discussion does not resolve your problem, you have the right to file a grievance with the ESRD Network in your area. You can find your Network in the listing below. Your social worker can also give you more information about how the Network grievance system works.
FOR ADDITIONAL HELP
If you have questions about kidney dialysis of transplant services in your area, contact your local ESRD Network Organization (see below).
If you have any questions about Medicare, contact your nearest Social Security office of the Medicare insurance carrier in your area. The carriers are listed in the back of Your Medicare Handbook, which is available from the Social Security office. You may also call the Medicare Hotline at 1-800-638-6833. If you use a TTY/TDD the telephone number is 1-800-820-1202.
This publication can also be found on the Internet at HCFA’s Web site address, http://www.hcfa.gov.
ESRD NETWORK ORGANIZATIONS
The ESRD Network Organizations are established by law and are organized into 18 geographic areas throughout the United States, Guam, Puerto Rico and American Samoa. The Network Organizations, listed below, are comprised of hospitals, kidney dialysis units, transplant centers, medical professionals and patients. The organizations are responsible for developing criteria and standards for the quality and appropriateness of patient care; assessing the appropriateness of treatment methods for patients; and making sure that the Renal Registry is maintained.
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States of Maine, New Hampshire, (ESRD Network Organization No. 1) ESRD Network of New England PO Box 9484 New Haven, Connecticut 06534 (203) 387-9332 |
States of New Mexico, Colorado, (ESRD Network Organization No. 15) Intermountain ESRD Network, Inc. 1301 Pennsylvania Street, Suite 220 Denver, Colorado 80203-5012 (303) 831-8818 |
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State of New York (ESRD Network Organization No. 2) ESRD Network of New York, Inc. 1216 5th Avenue, Room 456 New York, New York 10029 (212) 289-4524 |
States of Montana, Alaska, Idaho, (ESRD Network Organization No. 16) Northwest Renal Network 2701 First Avenue, Suite 430 Seattle, Washington 98121 (206) 448-1803 |
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State of New Jersey and Territories of (ESRD Network Organization No. 3) TransAtlantic Renal Council Cranbury Plaza 2525 Route 130, Building C Cranbury, New Jersey 08512 (609) 395-5544 |
State of Florida ESRD Network of Florida, Inc. 1 Davis Boulevard, Suite 304 Tampa, Florida 33606 (813) 251-8686 |
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District of Columbia and States of (ESRD Network Organization No. 5) Mid-Atlantic Renal Coalition 1527 Huguenot Road Midlothian, Virginia 23113 (804) 794-3757 |
States of Alabama, Mississippi and (ESRD Network Organization No. 8) Network Eight, Incorporated PO Box 55868 Jackson, Mississippi 39296-5868 (601) 936-9260 |
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States of Georgia, North Carolina (ESRD Network Organization No. 6) Southeastern Kidney Council, Inc. 900 Ridgefield Drive Lake Plaza East, Suite 150 Raleigh, North Carolina 27609 (919) 876-7545 |
States of Missouri, Iowa, Nebraska and Kansas (ESRD Network Organization No. 12) ESRD Network Organization No. 12 7509 Northwest Tiffany Springs Parkway, Suite 105 Kansas City, Missouri 64153 (816) 880-9990 |
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States of Pennsylvania and Delaware (ESRD Network Organization No. 4) University of Pittsburgh Medical Center 200 Lothrop Street Pittsburgh, Pennsylvania 15213-2582 (412) 647-3428 |
States of Arkansas, Louisiana and Oklahoma(ESRD Network Organization No. 13) ESRD Network Organization No. 13 625 NW 13th Street Oklahoma City, Oklahoma 73103-2232 (405) 523-2127 |
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States of Kentucky, Indiana and Ohio (ESRD Network Organization No. 9) TriState Renal Network, Inc. 911 E. 86th Street, Suite 202 Indianapolis, Indiana 46240-1858 (317) 257-8265 |
Northern California, Hawaii, Pacific Trust Territory, Guam and American Samoa(ESRD Network Organization No. 17) TransPacific ESRD Network 25 Mitchell Blvd., Suite 7 San Rafael, California 94903 (415) 472-8590 |
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State of Illinois (ESRD Network Organization No. 10) TriState Renal Network, Inc. 911 E 86th Street, Suite 202 Indianapolis, Indiana 46240-1858 (317) 257-8265 |
Southern California (ESRD Network Organization No. 18) ESRD Network Organization No. 18 6255 Sunset Blvd., Suite 2211 Hollywood, California 90028 (213) 962-2020 |
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States of Michigan, Minnesota, Wisconsin, North Dakota and South Dakota(ESRD Network Organization No. 11) Renal Network of the Upper Mid-West, Inc. (Central Office) 970 Raymond Avenue, Suite 205 St. Paul, Minnesota 55114 (612) 644-9877 |
State of Texas (ESRD Network Organization No. 14) ESRD Network of Texas, Inc. 14114 Dallas Parkway, Suite 660 Dallas, Texas 75240-4381 (972) 503-3215 |
