LCD/NCD Portal

NCD110.15

 

ULTRAFILTRATION, HEMOPERFUSION AND HEMOFILTRATION

 

Effective Date of this Version

8/20/1987

 

Benefit Category

• Inpatient Hospital Services.

• Institutional Dialysis Services and Supplies.

• Outpatient Hospital Services Incident to a Physician's Service.

• Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

 

Indications and Limitations of Coverage

 

Ultrafiltration

• This is a process for removing excess fluid from the blood through the dialysis membrane by means of pressure. It is not a substitute for dialysis.

o Ultrafiltration is utilized in cases where excess fluid cannot be removed easily during the regular course of hemodialysis.

o When it is performed, it is commonly done during the first hour or two of each hemodialysis on patients who, e.g., have refractory edema.

o Ultrafiltration is a covered procedure under the Medicare program (effective for services performed on and after September 1, 1979).

• Predialysis Ultrafiltration

o While the predialysis ultrafiltration procedure requires additional staff care, the facility dialysis rate is intended to cover the full range of complicated and uncomplicated nonacute dialysis treatments.

 Therefore, no additional facility charge is recognized for predialysis ultrafiltration.

 The physician's role in ultrafiltration varies with the stability of the patient's condition.

 In unstable patients, the physician may need to be present at the initiation of dialysis and available either in- house or in close proximity to monitor the patient carefully.

 In patients who are relatively stable, but who seem to accumulate excessive weight gain, the procedure requires only a modest increase in physician involvement over routine outpatient hemodialysis.

• Occasionally, medical complications may occur which require that ultrafiltration be performed separate from the dialysis treatment, and in these cases an additional charge can be recognized.

o However, the claim must be documented as to why the ultrafiltration could not have been performed at the same time as the dialysis.

 

Hemoperfusion

• This is a process which removes substances from the blood using a charcoal or resin artificial kidney.

o When used in the treatment of life threatening drug overdose, hemoperfusion is a covered service for patients with or without renal failure.

o Hemoperfusion generally requires a physician to be present to initiate treatment and to be present in the hospital or an adjacent medical office during the entire procedure, as changes may be sudden.

o Special staff training and equipment are required.

• Develop charges for hemoperfusion in the same manner as for any new or unusual service.

o One or two treatments are usually all that is necessary to remove the toxic compound; document additional treatments.

o Hemoperfusion may be performed concurrently with dialysis, and in those cases payment for the hemoperfusion reflects only the additional care rendered over and above the care given with dialysis.

• The effects of using hemoperfusion to improve the results of chronic hemodialysis are not known.

o Therefore, hemoperfusion is not a covered service when used to improve the results of hemodialysis.

o In addition, it has not been demonstrated that the use of hemoperfusion in conjunction with deferoxamine (DFO), in treating symptomatic patients with iron overload, is efficacious.

o There is also a paucity of data regarding its efficacy in treating asymptomatic patients with iron overload.

o Therefore, hemoperfusion used in conjunction with DFO in treating patients with iron overload is not a covered service.

 It is not considered reasonable and necessary within the meaning of §1862(a)(1) of the Act.

• However, the use of hemoperfusion in conjunction with DFO for the treatment of patients with aluminum toxicity has been demonstrated to be clinically efficacious and is therefore regarded as a covered service.

 

Hemofiltration

• This is a process which removes fluid, electrolytes and other low molecular weight toxic substances from the blood by filtration through hollow artificial membranes and may be routinely performed in 3 weekly sessions.

o Hemofiltration (which is also known as diafiltration) is a covered procedure under Medicare and is a safe and effective technique for the treatment of ESRD patients and an alternative to peritoneal dialysis and hemodialysis.

o In contrast to both hemodialysis and peritoneal dialysis treatments, which eliminate dissolved substances via diffusion across semipermeable membranes, hemofiltration mimics the filtration process of the normal kidney.

o The technique requires an arteriovenous access. Hemofiltration may be performed either in facility or at home.

• The procedure is most advantageous when applied to high-risk unstable patients, such as older patients with cardiovascular diseases or diabetes, because there are fewer side effects such as hypotension, hypertension or volume overload.

 

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