Waiver of Face-to-Face Visit for Home Dialysis Patients

Noridian may waive the Medicare monthly face-to-face visit requirement for home dialysis patients when physicians bill ESRD Monthly Capitation (CPT 90963-90966) with the -52 modifier and enter 'No Face-to-Face' in Item 19, provided the physician actively managed the patient during the month. The waiver is discretionary, applies monthly, does not apply to in-center dialysis patients, and Noridian may request medical records to verify adequate management per IOM Publication 100-04, Chapter 8, Section 140.1.1.

"A waiver of the monthly face-to-face visit requirement is permitted for home dialysis patients when billing the ESRD Monthly Capitation CPT code range 90963-90966 with the -52 modifier and document..."

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