Response to Comments: Frequency of Hemodialysis

This policy permits consideration of payment for hemodialysis treatments beyond the standard thrice-weekly baseline when claims include a MAC-approved diagnosis and medical records document medical necessity; claims for unlisted clinical situations may be submitted with a KX modifier to indicate attestation of medical necessity. MACs cannot change CMS base payment methodology, home-dialysis/more-frequent-as-baseline issues are out of scope and must be addressed to CMS, and initial denials for non-listed diagnoses are subject to the normal appeals and secondary review process which may result in LCD diagnostic list updates.

"Additional payment beyond the standard thrice-weekly hemodialysis payment may be considered when the claim includes a diagnosis on the MAC-approved list of clinical conditions and the medical recor..."

Sign up to see full coverage criteria, indications, and limitations.