Q&A: Changes to inpatient dialysis MS-DRGs

September 28, 2020
Medicare Web

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.