Changes to Inpatient Dialysis MS-DRGs

CMS created three new MS-DRGs whose relative weights will be calibrated to account for hemodialysis costs and will therefore be excluded from additional ESRD payments.

A version of this article was first published September 29, 2020, by HCPro's Revenue Cycle Advisor, a sibling publication to HealthLeaders.

Q: What changes to inpatient dialysis MS-DRGs did CMS finalize in the fiscal year 2021 Inpatient Prospective Payment System final rule?

A: CMS made several changes to reimbursement for inpatient dialysis.

Medicare will continue to pay an additional amount to hospitals for stays during which end-stage renal disease (ESRD) beneficiaries receive dialysis treatment, as long as ESRD beneficiary discharges constitute 10% or more of total Medicare discharges.

However, CMS created three new MS-DRGs whose relative weights will be calibrated to account for hemodialysis costs and will therefore be excluded from additional ESRD payments:

1. MS-DRG 019 (Simultaneous Pancreas/Kidney Transplant with Hemodialysis)
2. MS-DRG 650 (Kidney Transplant with Hemodialysis with MCC)
3. MS-DRG 651 (Kidney Transplant with Hemodialysis without MCC)

CMS is also removing MS-DRGs 652 and 685 from the list of MS-DRGs excluded from additional ESRD payments.

For more informaiton, see "Note from the instructor: FY 2021 IPPS payment factors and related adjustments," by Judith L. Kares, JD.