Response to Comments: Frequency of Hemodialysis DL37575

MACs developed a list of clinical conditions that may justify payment for hemodialysis beyond the standard thrice-weekly Medicare base payment; coverage of extra sessions requires supporting medical documentation demonstrating medical necessity for a listed condition. Services not on the list can be billed with a KX modifier and appropriate documentation, but MACs cannot change CMS base payment policy and issues like establishing home or more-frequent dialysis as a payment baseline must be addressed to CMS; denials may be appealed via redetermination.

"Hemodialysis treatments beyond the standard thrice-weekly Medicare base payment are eligible for additional payment when the beneficiary has a clinical condition included on the MAC-developed list ..."

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