Response to Comments: Frequency of Hemodialysis

This LCD clarifies that Medicare’s standard payment covers thrice-weekly hemodialysis and that additional payments for treatments beyond thrice-weekly may be allowed for ESRD patients when a clinical condition listed in the LCD or a KX-appended justification with supporting medical documentation demonstrates medical necessity. MACs cannot change CMS base payment policies or establish more frequent dialysis as the baseline; claims lacking supportive documentation may be denied but can undergo redetermination (appeals), and uncoded situations may be considered with a KX modifier and subsequent review.

"End Stage Renal Disease (ESRD) patients with a clinical condition listed in the Local Coverage Determination (LCD) are eligible for payment for hemodialysis treatments beyond the standard thrice-we..."

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