Where the physician has not elected the comprehensive monthly payment, otherwise covered
patient-care services of a nonsupervisory nature are reimbursable on a reasonable
charge basis. Generally, they include but are not limited to, the following kinds
of services: monthly and semiannual examinations, treatment of medical disabilities
associated with renal disease, such as hypotension and hypertension—including acute
medical emergencies, as well as incidental diagnosis and treatment of other acute
and chronic medical conditions; administration of blood; insertion of fistula needles
in difficult cases; shunt cannula declotting; and management during the dialysis procedure
of medical problems which are not necessarily related to the dialysis process or to
renal disease.
When bills are submitted for such physicians' personal services, the carrier requires
medical documentation of their necessity. Bills for physicians' personal services
in connection with maintenance dialysis are not allowed without clear evidence of
medical necessity.