Billing and Coding: Frequency of Hemodialysis

Line-item billing is required for all ESRD hemodialysis sessions (DOS on/after 2007-04-01). Routine coverage includes up to 3 treatments per week (up to 13/14 per month) billed as CPT 90999 with no modifier; additional sessions require medical documentation and must be billed as 90999 KX to be considered for extra payment, while extra sessions without supporting documentation must be billed 90999 CG and will be denied. Refer to LCD L37575 and NCCI guidance for full documentation, utilization, and coding rules.

"Each hemodialysis session for End Stage Renal Disease (ESRD) must be reported on a separate line for dates of service on or after 2007-04-01."

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