Frequency of Hemodialysis

Medicare ordinarily reimburses conventional hemodialysis at 3 sessions per week (13–14 sessions/month). Additional sessions (commonly 4–6/week) may be paid only when one of the covered indications (e.g., metabolic derangements, uncontrolled fluid overload, pregnancy, heart failure, pericarditis, incomplete dialysis from hypotension or access issues, or inadequate Kt/V <1.2 despite optimization) is documented, the claim uses the KX modifier, and the medical record supports medical necessity; otherwise sessions beyond 3/week will be denied or paid only at the 3/week rate.

"Metabolic derangements (acidosis, hyperkalemia, or hyperphosphatemia) that require additional hemodialysis sessions beyond the standard schedule."

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