Billing and Coding: Frequency of Hemodialysis

Medicare requires line-item billing for ESRD hemodialysis sessions and pays routine conventional hemodialysis up to three times per week (13–14 per month) billed as 90999 without a modifier. Sessions beyond three per week require medical documentation to be considered for payment and should be billed as 90999 KX (otherwise billed as 90999 CG and denied); the Plan of Care and supporting medical records must be available to justify additional sessions.

"Routine hemodialysis sessions prescribed and furnished three times per week should be billed as 90999 with no modifier and will be paid as routine conventional dialysis (up to 13/14 sessions per mo..."

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