ArticleActive
Response to Comments: Frequency of Hemodialysis
A56224
Novitas Solutions, Inc. (J12)
Effective: January 10, 2019
Updated: December 31, 2025
Policy Summary
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.
Coverage Criteria Preview
Key requirements from the full policy
"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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