TL;DR: The Centers for Medicare & Medicaid Services modified NCD 197, the national coverage determination governing the Peridex CAPD Filter Set for home peritoneal dialysis patients, effective March 7, 2026. The policy maintains non-coverage. Here's what that means for your billing team.
The CMS Peridex CAPD Filter Set coverage policy under NCD 197 in the Medicare system is straightforward — and not in a good way for suppliers or patients. CMS denies coverage for the Peridex Filter Set because clinical evidence has not shown it to be safe and effective in preventing peritonitis. No specific HCPCS codes are listed in the policy document. Billing teams submitting claims for this item should expect denial.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | CMS (Centers for Medicare & Medicaid Services) |
| Policy | Peridex CAPD Filter Set — NCD 197 |
| Policy Code | NCD 197 |
| Change Type | Modified |
| Effective Date | 2026-03-07 |
| Impact Level | Medium |
| Specialties Affected | Nephrology, Home Dialysis Suppliers, DME Suppliers, Home Health |
| Key Action | Do not submit Medicare claims for the Peridex CAPD Filter Set — this item is non-covered under NCD 197, and claims will be denied. |
CMS Peridex CAPD Filter Set Coverage Criteria and Medical Necessity Requirements 2026
NCD 197 is the National Coverage Determination governing Medicare coverage of the Peridex CAPD Filter Set for home continuous ambulatory peritoneal dialysis patients. CMS applies this coverage policy nationally. No Medicare Administrative Contractor (MAC) has discretion to override it at the local level.
The medical necessity bar here is simple: the Peridex Filter Set doesn't clear it. CMS determined — based on its medical consultants' advice — that the device has not been shown to be safe and effective in preventing peritonitis. That's the specific clinical standard CMS used, and it's why the item is not covered.
Whether a patient genuinely needs sterile filtration during dialysis solution infusion into the peritoneal cavity is not the issue. The clinical rationale for the device makes sense. The problem is that CMS requires evidence the device actually works for that purpose, and that evidence hasn't been produced to CMS's satisfaction.
For billing teams, the practical answer to "whether the Peridex CAPD Filter Set is covered under Medicare" is no — and NCD 197 makes that position binding across all Medicare payers and all MACs nationally. There are no prior authorization pathways here. Prior authorization is not the issue. The item is categorically non-covered.
CMS Peridex CAPD Filter Set Exclusions and Non-Covered Indications
This entire policy is an exclusion. The Peridex CAPD Filter Set is not covered under Medicare — full stop. CMS does not list exceptions or covered subsets.
The device is used during infusion of dialysis solution into the peritoneal cavity of home CAPD patients. It includes a bacterial filter intended to block peritonitis-causing organisms. That's a clinically logical application. But CMS's position is that logical doesn't mean proven, and Medicare reimbursement requires proof of safety and effectiveness.
This is the classic pattern for items in a non-coverage NCD: the device has a plausible mechanism of action, but clinical data hasn't convinced CMS. Until that changes — until CMS modifies or reconsiders NCD 197 based on new evidence — your claims will be denied. Don't treat this as a gray area where creative billing guidelines might get a claim through. It won't.
If you're billing for other peritoneal dialysis supplies and want to know where the line is, talk to your MAC. NCDs set the national floor. Your MAC's local coverage determinations (LCDs) may address related items in more detail.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Peridex CAPD Filter Set for sterile filtration during home peritoneal dialysis | Not Covered | None listed in policy | Non-covered under NCD 197; CMS finds insufficient evidence of safety and effectiveness in preventing peritonitis |
| Bacterial filtration to reduce peritonitis incidence in CAPD patients | Not Covered | None listed in policy | Device mechanism is acknowledged but clinical evidence does not meet CMS medical necessity threshold |
CMS Peridex CAPD Filter Set Billing Guidelines and Action Items 2026
The modified effective date of March 7, 2026 doesn't create new obligations so much as it reaffirms existing ones. Here's what your team should do right now.
| # | Action Item |
|---|---|
| 1 | Remove the Peridex CAPD Filter Set from your billable item list for Medicare before March 7, 2026. If your charge capture system includes this item as a potential Medicare claim, flag it for removal. Any claim submitted to Medicare for this device will be denied under NCD 197. |
| 2 | Audit claims filed since NCD 197 was last in effect. If your team has submitted any claims for the Peridex Filter Set under Medicare, pull those records. Identify any payments received and assess your exposure. Overpayments on non-covered items create repayment obligations. |
| 3 | Do not pursue prior authorization for this item. There is no prior auth pathway that unlocks Medicare reimbursement for a categorically non-covered item. Pursuing prior authorization here wastes time and creates false expectations for patients and clinical staff. |
| 4 | Notify clinical and billing staff that this device has no Medicare reimbursement path. Home dialysis coordinators, nephrology billing staff, and DME suppliers who work with CAPD patients should know this explicitly. The device may be presented by vendors as beneficial — and clinically, it may be. That doesn't change the Medicare coverage policy. |
| 5 | Document and communicate ABN requirements to patients. If a patient requests the Peridex Filter Set and you plan to supply it, issue an Advance Beneficiary Notice of Noncoverage (ABN) before providing the item. This protects you from liability and informs the patient they'll bear the cost. Get the ABN signed before the service — not after. |
| 6 | Check for non-Medicare payer coverage separately. This NCD applies to Medicare. Some commercial payers may cover the Peridex Filter Set under their own policies. Check each commercial payer's coverage policy independently before billing. Don't assume Medicare's non-coverage ruling carries over to Cigna Healthcare, UnitedHealthcare, or other payers. |
| 7 | If you're a DME supplier with significant home dialysis volume, loop in your compliance officer. The intersection of home dialysis billing, non-covered items, and ABN requirements has real regulatory exposure. If you're not sure how NCD 197 applies to your patient mix or billing workflows, talk to your compliance officer before the effective date of March 7, 2026. |
| 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
The NCD 197 policy document does not list specific CPT, HCPCS Level II, or ICD-10-CM codes for the Peridex CAPD Filter Set. This is worth noting for two practical reasons.
First, the absence of a specific HCPCS code in the policy doesn't mean your claim will slip through undetected. Medicare claims processing edits can flag non-covered items through multiple pathways, including manual review and supplier audits. Don't assume a missing code creates a billing workaround.
Second, if your MAC has issued a local coverage determination or billing article that assigns a specific HCPCS code to peritoneal dialysis filter sets or related supplies, that local guidance governs how you code and submit — but it doesn't override the national non-coverage determination. An NCD outranks an LCD when they conflict. Non-coverage at the NCD level means non-coverage regardless of what code you use.
No Covered Codes Under NCD 197
| Code | Type | Description |
|---|---|---|
| Not listed in policy | — | The Peridex CAPD Filter Set has no covered billing code under Medicare NCD 197 |
Not Covered
| Item | Status | Reason |
|---|---|---|
| Peridex CAPD Filter Set | Not Covered | CMS determined the device has not been shown to be safe and effective in preventing peritonitis; no HCPCS code assigned in policy |
What This Policy Change Actually Means
The modification to NCD 197 on March 7, 2026 doesn't flip coverage. It doesn't narrow criteria or add exceptions. It reaffirms and restates a non-coverage position that CMS has held.
That might feel like nothing changed. But policy modifications — even reaffirmations — matter to billing teams for a specific reason. A modified NCD resets the clock on how actively CMS intends to enforce the policy. It signals that auditors and MACs have a current, reviewed basis for denying claims. "We didn't know" becomes harder to argue after a published modification.
The real issue here is peritoneal dialysis billing broadly. CAPD patients rely on a range of home supplies, and the line between covered and non-covered items in this category is not always obvious. The Peridex Filter Set is a clear case — it's in an NCD, it's non-covered, there's no gray area. But if your team is billing for other home dialysis supplies and equipment under the durable medical equipment benefit category, make sure those items have solid coverage determinations backing them up.
Don't let a clear non-coverage NCD like this one slide into your charge capture unchecked. The claim denial rate on non-covered items is 100%. That's not a billing problem you audit your way out of — it's one you prevent upfront.
Get the Full Picture
Track this policy across versions, search 1,500+ policies by CPT code, and get real-time alerts when any payer changes coverage.