Local Coverage Article

Waiver of Face-to-Face Visit for Home Dialysis Patients


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Waiver of Face-to-Face Visit for Home Dialysis Patients
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Article Guidance

Article Text
Physician management services for patients on dialysis are usually paid for a full month of management services. For in-center dialysis patients, this is billed and paid based on the number of face-to-face visits made during the month and the age bracket of the patient. For home dialysis patients there is a single fee based on the age bracket of the patient. Medicare requires that physicians billing this service must provide certain minimal services including at least one face-to-face visit each month to assess the condition of the vascular access.

Since 2011, CMS has allowed payment of the ESRD Monthly Capitation (MCP) for certain home dialysis patients even when the physician has not actually had a face-to-face visit; this requires an individual waiver at contractor discretion (IOM 100-04, Chapter 8, Section 140.1.1). Starting July 7, 2016, physicians may request this waiver by appending the -52 modifier (reduced services) to the appropriate monthly capitation CPT code (90963 – 90966).

Place the words, “No Face-to-Face” in Item 19 (or electronic equivalent). Noridian may request medical records to assess whether the notes support that the physician actively and adequately managed the care of the home dialysis patient throughout the month. Noridian expects that requests for these waivers will be unusual.

References: Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 8, Section 140.1.1 at MCPM

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Updated On Effective Dates Status
05/13/2016 07/07/2016 - N/A Currently in Effect You are here


  • ESRD
  • Monthly Capitation
  • MCP
  • 90963
  • 90964
  • 90965
  • 90966
  • waiver
  • face to face
  • home visit
  • dialysis