MedicaidCoverageHigh impact
Dialysis Services in the Emergency Department of Hospitals
Maryland Medicaid·MD · Emergency Medicine, Nephrology·Provider Transmittal
Effective date
Jun 9, 2022
We identified it
Jun 20, 2026
Summary
Maryland Medicaid will only reimburse for renal dialysis in hospital Emergency Departments if it is medically necessary and emergent—meaning the patient cannot safely receive routine dialysis at their community provider. Starting in 2022, Maryland Medicaid will resume monitoring claims to prevent reimbursement of routine dialysis services in EDs. Hospitals that have been reimbursed for routine, non-emergency dialysis may face fund recoupment.
Action Required
Immediately (effective June 9, 2022): Billing team and ED providers must implement claim review controls to ensure dialysis services billed to Maryland Medicaid in the ED are documented as emergency/medically necessary only. Specifically: (1) Update billing software or manual review processes to flag all dialysis claims from the ED for medical necessity validation before submission; (2) Require ED providers to document in the patient record why the patient could not safely receive routine dialysis at their community provider (this documentation must accompany all ED dialysis claims); (3) Audit all dialysis claims submitted to Maryland Medicaid since the previous policy (PT 23-13, issued May 1, 2013) to identify any routine/non-emergency dialysis billed; (4) Contact Denise James (denise.james@maryland.gov) if the practice identifies historical claims for routine dialysis, as hospitals may be subject to recoupment. Failure to implement these controls risks claim denials and potential fund recovery by Maryland Medicaid.