Benefit: Dialysis Services

Definition: Dialysis is a process that 1) uses a machine to purify the blood of waste and excess fluids or 2) injects a fluid into the abdominal cavity that causes excess fluids to drain out the body because the kidneys don’t work (renal failure). Dialysis services include routine laboratory tests, machine use and/or the injection of medication by a licensed physician. It also includes dialysis-related supplies.

Limits:  Medicaid will only pay for dialysis services provided in a freestanding dialysis center and are limited to one treatment per recipient, per day, up to three times per week. Medicaid will pay for home peritoneal dialysis and is limited to one treatment per recipient, per day. Medicaid pays for the medication Erythropoietin (Epogen or EPO) and is limited to up to three times per week. The weekly maximum number of treatments may be exceeded if additional treatments are determined to be medically necessary by the recipient’s nephrologist (kidney disease doctor) or primary care physician.

Exceptions:  Medicaid does not cover any services other than hemodialysis (the removing of waste products and excess fluids from the blood) and the administering of the injectable medication Erythropoietin (Epogen or EPO) in a freestanding dialysis center, and home peritoneal dialysis supplies provided by a freestanding dialysis center.

Co-pays: None

Reform items that can vary: None