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Services
Provider Notice issued 06/30/2026
Changes to Renal Dialysis Billing and Payment and Renal Dialysis $95.00 Add-On Payment Per Public Act 103-0593 for Long Term Care Residents
| To: |
Enrolled Hospitals; Renal Dialysis Clinics; and Long Term Care Facilities – Nursing Facilities |
| Re: |
Changes to Renal Dialysis Billing and Payment and Renal Dialysis $95.00 Add-On Payment Per Public Act 103-0593 for Long Term Care Residents |
| Date: | June 30, 2026 |
This notice informs providers of updates to renal dialysis billing and payment, applicable to both the fee-for-service and managed care programs.
Revenue Codes and Condition Codes
Effective June 1, 2026, the Department of Healthcare and Family Services (HFS) will require that renal dialysis providers bill one of the appropriate revenue codes listed below, based on the type of dialysis provided.
For dialysis provided at home, the provider must include Condition Code 74. For dialysis provided in a long-term care setting, Condition Code 80 is required.
Revenue Codes for Dialysis.
| Revenue Code | Type | Location | Definition |
| 0821 | Hemodialysis | Outpatient or Home | A waste removal process performed in an outpatient or home setting, necessary when the body’s own kidneys have failed. Waste is removed directly from the blood. |
| 0831 | Peritoneal Dialysis | Outpatient or Home | A waste removal process performed in an outpatient or home setting, necessary when the body’s own kidneys have failed. Waste is removed indirectly by instilling a special solution into the abdomen using the peritoneal membrane as a filter. |
| 0841 | Continuous Ambulatory Peritoneal Dialysis (CAPD)
|
Outpatient or Home
|
A continuous dialysis process performed in an outpatient or home setting, which uses the patient’s peritoneal membrane as a dialyzer. |
| 0851 | Continuous Cycling Peritoneal Dialysis (CCPD) | Outpatient or Home | A continuous dialysis process performed in an outpatient or home setting, which uses the patient’s peritoneal membrane as a dialyzer. |
Pricing Policy Change
Previously, the Department paid for Continuous Cycling Peritoneal Dialysis (CCPD, Revenue Code 0851) and Continuous Ambulatory Peritoneal Dialysis (CAPD, Revenue Code 0841) services provided in a patient’s home at 3/7th of the rate for services provided in dialysis facilities. These dialysis services in the home will now be paid at the full facility-based rate.
$95 Add-on Payment Per Public Act 103-0593
For a dialysis facility to receive the $95.00 add-on payment per treatment day for a resident within a nursing facility, the dialysis facility must identify Condition Code 80 on the resident’s claim. Nursing facility coverage must be identified in the HFS Recipient Data Base for the dates of service on the claim for the add-on to be paid.
Adjustments
For services provided June 1, 2026, and after, dialysis providers must void and rebill any previously paid claims for nursing facility residents receiving home dialysis to receive the $95.00 add-on payment.
Fee-for-service claims only: For the 3/7 rate pricing change, providers do not need to rebill claims. The Department will adjust the claims automatically.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for fee-for-service claims, or the applicable MCO.
Laura Phelan, Administrator
Division of Medical Programs