Response to Comments: Frequency of Hemodialysis

Novitas permits payment for hemodialysis sessions beyond the standard thrice-weekly schedule when the beneficiary has a diagnosis included in LCD DL35014 and the medical record documents clinical necessity; treatments for diagnoses not on the list may be billed with a KX modifier and are subject to review. Local Contractors cannot change CMS base ESRD payment policy; denials may be appealed via the redetermination process and diagnosis codes may be added to the LCD following review.

"Payment for hemodialysis sessions beyond the standard thrice-weekly schedule is covered when the beneficiary has a clinical diagnosis listed in Novitas LCD DL35014 and the medical record documents ..."

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