Billing and Coding: Frequency of Hemodialysis

Medicare pays routine hemodialysis for ESRD patients up to 3 sessions per week (paid as routine dialysis, up to 13/14 sessions per month) with each session reported on a separate line (code 90999, no modifier). Additional sessions beyond 3/week must be supported by medical documentation to be considered for extra payment (bill as 90999 KX); sessions without such documentation should be billed as 90999 CG and will be denied. All supporting records (including a legible Plan of Care, patient identifiers, dates of service, and provider signature) must be maintained and available to the contractor, and NCCI and other coding rules take precedence.

"For ESRD patients, routine in-facility or home hemodialysis furnished 3 times per week should be billed as CPT/HCPCS code 90999 with no modifier and will be paid as routine conventional dialysis (u..."

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