Billing and Coding: Frequency of Hemodialysis

Medicare pays routine hemodialysis when prescribed and furnished three times per week—each session billed as CPT 90999 with no modifier and reimbursed up to about 13–14 sessions per month. Treatments beyond three per week must be billed as 90999 KX with supporting medical documentation (e.g., hospital notes, office visits, dialysis progress notes) to be considered for additional payment; sessions billed as 90999 CG indicate lack of medical necessity and will be denied. Each dialysis session must be reported on a separate line (CMS IOM requirement), and claims using Bill Type 72X with Revenue Codes 0821/0881 should follow the three billing approaches based on the patient’s Plan of Care.

"When hemodialysis is prescribed and furnished three times per week, bill each session as CPT 90999 with no modifier; these sessions will be paid as routine conventional dialysis."