Billing and Coding: Frequency of Hemodialysis

Medicare pays up to three hemodialysis treatments per week (typically up to 13/14 per month) for ESRD patients; each furnished session must be billed on a separate line as CPT 90999 with no modifier for routine 3x/week treatments. Additional sessions beyond three per week may be billed with modifier KX and supporting medical documentation for consideration of extra payment, while sessions billed with modifier CG indicate lack of medical necessity and will be denied. Maintain the patient’s Plan of Care and supporting medical records (e.g., hospital notes, office visits, dialysis progress notes) and use bill type 72X with revenue codes 0821/0881 for monthly claims.

"Bill each furnished hemodialysis session as CPT 90999 (no modifier) when the hemodialysis prescription is three times per week and each session is actually furnished."

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