MedicaidReimbursementHigh impact
[Ohio] OAC 5160-13-08, Add-On Payment for Nursing Facility-Based Hemodialysis Furnished by a Dialysis Center
CareSource·OH · Nephrology·Claims & Billing
Effective date
Jul 1, 2026
We identified it
Jul 1, 2026
Summary
Ohio Medicaid (ODM) has implemented a new add-on payment of $110 per treatment for nursing facility-based hemodialysis services furnished by dialysis centers, effective July 1, 2026. Billing teams must use the designated HD revenue center code with an ODM-specified modifier to claim this add-on payment, which is available only during SFY 2027, for dialysis centers already providing these services, and until the $2.1M budget cap is reached.
Action Required
By July 1, 2026: Billing team must implement the following changes: (1) Update billing software to recognize and process the $110 add-on payment for nursing facility-based HD services; (2) Identify and configure the ODM-specified modifier that must accompany HD revenue center codes (contact CareSource Provider Services at 1-800-488-0134 for specific modifier code, as it is not detailed in this notice); (3) Implement date range validation to ensure claims are dated within SFY 2027 only; (4) Add logic to flag claims for dialysis centers NOT already providing nursing facility-based HD services on or before June 30, 2026, as ineligible; (5) Create monitoring system to track cumulative add-on payment expenditures against the $2.1M budget cap and stop processing add-on claims once cap is reached; (6) Configure system to discontinue add-on payments for dual Medicare/Medicaid beneficiaries once Medicare coverage begins. Train all billing and coding staff on new modifier requirements and eligibility criteria. Failure to properly code and bill this add-on will result in lost revenue for the practice.