Response to Comments: Frequency of Hemodialysis

Medicare payment for hemodialysis beyond the standard thrice-weekly schedule may be authorized only for specific clinical conditions listed in the Local Coverage Determination and when supporting medical documentation demonstrates medical necessity. Claims lacking a listed diagnosis can be annotated with the KX modifier to trigger additional review, and providers may appeal denials or request that new diagnosis codes be added to the LCD; MACs cannot change CMS base payment policies and issues like making home or more frequent dialysis the baseline must be resolved by CMS.

"Payment for hemodialysis sessions beyond the standard thrice-weekly schedule is covered when the claim includes a clinical condition listed in the Local Coverage Determination and supporting medica..."

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