TL;DR: The Centers for Medicare & Medicaid Services modified NCD 197, its National Coverage Determination governing the Peridex CAPD Filter Set for home peritoneal dialysis patients, effective March 7, 2026. The policy confirms non-coverage: CMS will not reimburse for the Peridex Filter Set under Medicare because the device has not been demonstrated to be safe and effective in preventing peritonitis. No specific CPT or HCPCS codes are listed in the policy. If your billing team submits claims for this device, expect denial.
| Field | Detail |
|---|---|
| Payer | Centers for Medicare & Medicaid Services (CMS) |
| Policy | Peridex CAPD Filter Set |
| Policy Code | NCD 197 |
| Change Type | Modified |
| Effective Date | 2026-03-07 |
| Impact Level | Medium — affects nephrology and home dialysis billing teams submitting claims for CAPD supplies |
| Specialties Affected | Nephrology, home dialysis, durable medical equipment (DME) suppliers |
| Key Action | Audit any open or pending claims for the Peridex CAPD Filter Set and do not submit new claims after March 7, 2026 |
CMS Peridex CAPD Filter Set Coverage Criteria and Medical Necessity Requirements 2026
NCD 197 is the National Coverage Determination that governs Medicare coverage of the Peridex Filter Set, a device used by patients on home continuous ambulatory peritoneal dialysis (CAPD). The filter set is designed to provide sterile filtration during infusion of dialysis solution into the peritoneal cavity. It includes a bacterial filter meant to block peritonitis-causing organisms and reduce the incidence of peritonitis — a serious and recurring complication in CAPD patients.
CMS's coverage determination is straightforward: the Peridex CAPD Filter Set does not meet Medicare's medical necessity standard. According to CMS's own medical consultants, the device has not been shown to be safe and effective in preventing peritonitis. That finding is the basis for non-coverage, and it's been the agency's position since this NCD was first issued.
The 2026 modification keeps that determination in place. There are no coverage exceptions, no prior authorization pathway that could unlock reimbursement, and no scenario under this policy where a Medicare claim for the Peridex Filter Set should be submitted with an expectation of payment. The billing guideline here is simple: don't bill it.
This NCD falls under Medicare's Home Dialysis Supplies and Equipment benefit category. That matters because some billing teams assume that if a supply is used in a covered home dialysis setting, the supply itself is covered. That assumption will get you a denial. The item must independently meet coverage criteria — and this one doesn't.
CMS Peridex CAPD Filter Set Exclusions and Non-Covered Indications
CMS is explicit: the Peridex CAPD Filter Set cannot be covered under Medicare at this time. The agency's rationale is an evidentiary one — the device hasn't cleared the bar of demonstrated safety and effectiveness for its intended purpose of peritonitis prevention.
This isn't a coverage gap or an administrative gray zone. It's a formal non-coverage determination. The phrase "at this time" in CMS policy language technically leaves the door open for future evidence to change the determination — but until CMS issues a new or revised NCD with a positive coverage finding, the policy is non-coverage, full stop.
If a physician orders the Peridex Filter Set for a Medicare patient on home CAPD, that order does not create a covered claim. Document the non-coverage clearly in your ABN (Advance Beneficiary Notice of Noncoverage) workflow so the patient understands they would bear the cost out of pocket if they choose to use the device.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Peridex CAPD Filter Set for home continuous ambulatory peritoneal dialysis — sterile filtration during dialysis solution infusion | Not Covered | No codes listed in NCD 197 | CMS determined device is not proven safe and effective for peritonitis prevention; ABN required if patient elects to proceed |
CMS CAPD Filter Set Billing Guidelines and Action Items 2026
| # | Action Item |
|---|---|
| 1 | Audit open claims immediately. Before March 7, 2026, pull any pending or unsubmitted claims that include the Peridex CAPD Filter Set and remove them. Submitting after the effective date is a clean path to denial. |
| 2 | Do not submit new claims for the Peridex Filter Set under Medicare. NCD 197 establishes non-coverage. There is no prior authorization process, no exception pathway, and no modifier that will rescue a claim for this device under CMS billing guidelines. |
| 3 | Issue ABNs for any patient who wants to use the device. If a patient on home CAPD wants to continue using the Peridex Filter Set despite Medicare's non-coverage, an Advance Beneficiary Notice of Noncoverage is required before the service. Without a valid ABN, your organization absorbs the cost. |
| 4 | Check your DME supplier agreements. If you work with a DME supplier that has been providing the Peridex Filter Set as part of a CAPD supply bundle, confirm they are not embedding it in a claim that gets billed to Medicare. Bundled supply claims can obscure a non-covered item until the denial hits. |
| 5 | Update your charge capture and order entry systems. Remove the Peridex Filter Set from any Medicare-billable supply lists in your practice management system or EHR order sets. An item sitting in a charge capture template is an invitation for an inadvertent claim submission. |
| 6 | Talk to your compliance officer if you're uncertain about claim history. If your organization has previously submitted claims for this device under Medicare, a compliance review of that claim history is worth doing before the March 7, 2026 effective date. Retroactive claim issues are easier to address proactively. This is exactly the kind of policy change where a conversation with your compliance officer or billing consultant before the date beats a repayment demand after it. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Peridex CAPD Filter Set Under NCD 197
NCD 197 does not list specific CPT, HCPCS Level II, or ICD-10-CM codes. This is worth flagging for your billing team — the absence of assigned codes is not unusual for older NCDs covering durable medical equipment and supplies, but it does mean you won't find a designated code to hang a denial-avoidance strategy on.
No Codes Listed in Policy Data
The policy data for NCD 197 contains no billable codes. CMS's determination applies to the Peridex CAPD Filter Set as a device/supply category under the Home Dialysis Supplies and Equipment benefit, not to a specific billing code.
If your DME supplier or billing team has been submitting claims for this item, work with them to identify what code, if any, was used — and confirm it aligns with the non-coverage determination. Do not invent or substitute codes to work around the coverage exclusion. That's the shortest route to a fraud and abuse issue.
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