CMS Ultrafiltration Monitor Form

The Ultrafiltration Monitor is designed to reduce the clinical risks of overfiltration and underfiltration during hemodialysis. Overfiltration is the removal of too much fluid from body tissues and underfiltration is removal of too little fluid.

Covered

Ultrafiltration and ultrafiltration monitoring as a component of hemodialysis has an established and critical role in maintaining the well-being of ESRD patients and is a covered service. The Ultrafiltration Monitor is covered under the Medicare program when it is used to calculate fluid rates for those recipients who present difficult fluid management problems. Determine the medical necessity of this device on a case-by-case basis.

Not Covered

Ultrafiltration, independent of conventional dialysis, is considered experimental, and technology exclusively designed for this purpose is not covered under Medicare.