MedicaidBilling CodesMedium impact
Provider Bulletin 01-21-2025 End Stage Renal Disease (ESRD) Bundled Payment IE LA SAC SD
Molina Healthcare·CA · Nephrology·Claims & Billing
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Summary
Effective January 1, 2025, oral-only phosphate binders for ESRD dialysis patients moved from pharmacy benefit (Part D) to medical benefit (Part B) and are now included in the ESRD bundled payment. Dialysis providers must use new HCPCS J-codes when billing for these oral phosphate binders.
Action Required
Immediately: Dialysis providers and billing teams must update billing systems to use the new HCPCS J-codes (J0601-J0609, J0615) for oral phosphate binders in ESRD patients on dialysis. These medications should now be billed under medical benefit (Part B) instead of pharmacy benefit (Part D). For oral renal dialysis drugs without designated HCPCS codes, report the National Drug Code (NDC) on claim forms.