Billing and Coding: Frequency of Hemodialysis

Medicare requires line-item billing for each hemodialysis session for ESRD claims (effective April 1, 2007). Routine payment covers up to 3 treatments per week (paid up to 13/14 per month) billed as CPT 90999 with no modifier; additional sessions beyond 3/week must be billed as 90999 KX with supporting medical documentation to be considered for extra payment, while sessions billed as 90999 CG (attested not reasonable/necessary) will be denied. Refer to LCD L37537 and NCCI guidance for full documentation, utilization guidelines, and applicable coding edits.

"Report each hemodialysis session for ESRD patients on a separate line for claims with dates of service on or after April 1, 2007."

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