Frequency of Hemodialysis

Medicare generally reimburses conventional hemodialysis at three sessions per week (13–14 per month); additional sessions beyond three per week are not considered reasonable and necessary unless supported by medical documentation and appropriate use of the KX modifier. Covered indications for extra sessions include metabolic derangements (acidosis, hyperkalemia, hyperphosphatemia), persistent volume overload, pregnancy, heart failure, pericarditis, and incomplete dialysis due to hypotension or access issues; documentation must include a POC (42 CFR 494.90), measures of adequacy (hemodialysis Kt/V ≥ 1.2), attempts to correct underlying problems, and adherence to Local Coverage Article A55672 requirements.

"Additional hemodialysis sessions beyond three per week are covered for metabolic derangements including metabolic acidosis, severe hyperkalemia, or severe hyperphosphatemia when supported by docume..."