Frequency of Hemodialysis

Medicare covers hemodialysis at a baseline of three sessions per week (13–14/month) and will only pay for additional sessions when specific medical indications are documented (eg, refractory metabolic derangements, uncontrolled fluid overload, pregnancy, heart failure, pericarditis, or incomplete dialysis due to hypotension/access issues). Claims exceeding three sessions per week require supporting medical records, appropriate use of the KX modifier, a Patient Plan of Care per 42 CFR 494.90 with Kt/V adequacy data (hemodialysis Kt/V ≥ 1.2 or equivalent), and documentation of attempts to correct underlying problems; planned short/inadequate sessions or sessions for convenience are not covered.

"Hemodialysis additional sessions are covered for metabolic derangements including acidosis, hyperkalemia, or hyperphosphatemia not controlled by routine dialysis."

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