N.M. Admin. Code § 8.325.2.13

Current through Register Vol. 35, No. 23, December 10, 2024

Section 8.325.2.13 - SERVICE LIMITATIONS

Tests that are listed as separately billable (not included in the composite rate) and are performed at a frequency greater than specified in the composite rate require medical justification and are covered when furnished at specified frequencies.

A. Tests for hemodialysis, peritoneal dialysis and CCPD: (Not included in the composite rate). These services may be billed separately at the specified frequencies.

(1) Monthly:

(a) alkaline phosphatase;

(b) alkaline phosphatase;

(c) blood urea nitrogen (BUN);

(d) serum bicarbonate (CO₂);

(e) dialysis protein;

(f) hematocrit;

(g) hemoglobin;

(h) lactic dehydrogenase (LDH);

(i) magnesium;

(j) serum albumin;

(k) serum creatinine;

(l) serum phosporus;

(m) serum potassium;

(n) SGOT;

(o) sodium;

(p) total protein;

(q) serum calcium;

(r) hepatitis test.

(2) Once every three months:

(a) serum aluminum;

(b) serum ferritin;

(c) nerve conductor velocity test;

(d) EKG.

(3) Once every six months: chest x-ray

(4) Once every year: bone survey

B. Tests for CAPD: (Not included in the composite rate). These services may be billed separately at the specified frequencies.

(1) Once every three months:

(a) white blood count (WBC);

(b) platelet count;

(c) red blood count.

(2) Once every six months:

(a) 24-hour urine volume;

(b) residual renal function;

(c) chest x-ray;

(d) EKG;

(e) MNCV.

C. Training: Medicaid reimburses for hemodialysis, peritoneal dialysis, continuous cycling peritoneal dialysis and continuous abdominal peritoneal dialysis training sessions if furnished by a renal dialysis facility certified to provide these services. Dialysis training must be performed in the dialysis facility. 15 training sessions are allowed without medical justification. To be reimbursed for additional training sessions, a medical justification must be attached to the claim.

N.M. Admin. Code § 8.325.2.13

8.325.2.13 NMAC - N, 11/1/04, Adopted by New Mexico Register, Volume XXXV, Issue 12, June 25, 2024, eff. 7/1/2024