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TRICARE Policy Manual 6010.60-M, April 1, 2015
Chapter 11
Section 2.10
Freestanding End Stage Renal Disease (ESRD) Facilities
Issue Date:  May 31, 2023
Revision:  C-110, May 31, 2023
Freestanding ESRD facilities rendering hemodialysis and peritoneal dialysis services for the treatment of ESRD and Acute Kidney Injury (AKI). Freestanding ESRD facilities are neither hospital-affiliated no hospital-based.
2.1  The contractor shall only refer to and pay claims for care provided in freestanding ESRD facilities that meet all the following criteria:
•  Are Medicare-certified ESRD facilities, and
•  Meet all Medicare conditions for coverage as provided in 42 CFR part 494, and
•  Are classified as freestanding ESRD facilities by Medicare, and
•  Are TRICARE Participating providers, and
•  Agree to accept the TRICARE payment as full payment for the care, services, or supplies, in accordance with Section 1.2.
2.2  Freestanding ESRD providers that meet these requirements are authorized TRICARE institutional providers.
2.3  Covered dialysis services are described in Chapter 7, Section 4.2.
2.4  Reimbursement rates and methods for freestanding ESRD facilities are described in the TRICARE Reimbursement Manual (TRM), Chapter 18, Section 1.
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