Billing and Coding: Dialysis Access Maintenance

This policy provides billing and documentation requirements for dialysis access maintenance claims billed to Medicare Part A or B, emphasizing compliance with Local Coverage Determination L34062 and applicable NCCI/OPPS edits. Claims must include a valid ICD-10-CM diagnosis code and, when applicable, the referring/ordering physician's name and NPI; ABN use must follow CMS rules (Form CMS-R-131, occurrence code 32 for Part A) and specific modifiers (-GA, -GX, -GZ, -GY) determine denial behavior.

"Claims for dialysis access maintenance billed to Medicare Part A or Part B should be submitted when coding conforms to the applicable Local Coverage Determination L34062 and applicable NCCI and OPP..."

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