Local Coverage Determination (LCD)

Frequency of Hemodialysis

L34575

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Contractor Information

LCD Information

Document Information

LCD ID
L34575
LCD Title
Frequency of Hemodialysis
Proposed LCD in Comment Period
N/A
Source Proposed LCD
DL34575
Original Effective Date
For services performed on or after 10/01/2015
Revision Effective Date
For services performed on or after 12/10/2020
Revision Ending Date
N/A
Retirement Date
N/A
Notice Period Start Date
01/03/2019
Notice Period End Date
02/17/2019
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CMS National Coverage Policy

This Local Coverage Determination (LCD) supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for additional hemodialysis sessions. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. They are not repeated in this LCD. Neither Medicare payment policy rules nor this LCD replace, modify or supersede applicable state statutes regarding medical practice or other health practice professions acts, definitions and/or scopes of practice. All providers who report services for Medicare payment must fully understand and follow all existing laws, regulations and rules for Medicare payment for additional hemodialysis sessions and must properly submit only valid claims for them. Please review and understand them and apply the medical necessity provisions in the policy within the context of the manual rules. Relevant Centers for Medicare and Medicaid Services (CMS) manual instructions and policies may be found in the following Internet-Only Manuals (IOMs) published on the CMS Web site:

Title XVIII of the Social Security Act, §1862(a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

CMS Internet-Only Manual, Pub 100-01, Medicare General Information, Eligibility and Entitlement Manual, Chapter 1, §10 General Program Benefits

CMS Internet-Only Manual, Pub 100-01, Medicare General Information, Eligibility and Entitlement Manual, Chapter 2, §10 Hospital Insurance Entitlement

CMS Internet-Only Manual, Pub 100-02, Medicare Benefit Policy Manual, Chapter 11, §60, 70, 90, 110-120, 140 End Stage Renal Disease (ESRD)

CMS Internet-Only Manual, Pub 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 2, §110.10 Intravenous Iron Therapy and §110.15 Ultrafiltration, Hemoperfusion and Hemofiltration

CMS Internet-Only Manual, Pub 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 4, §260.6 Dental Exam Prior to Kidney Transplantation

CMS Internet-Only Manual, Pub 100-04, Medicare Claims Processing Manual, Chapter 8, §40.5-40.85,60.4-60.4.1,60.5, 60.7-80.1,90.1-90.3,90.4-90.5,100-120.1,130.1,140.1-160.3,190-200 Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims, all sections including Section 140 Monthly Capitation Payment Method for Physicians’ Services Furnished to Patients on Maintenance Dialysis 

CMS Internet-Only Manual, Pub 100-05, Medicare Secondary Payer Manual, Chapter 2, §20 Medicare Secondary Payer Provisions for End-Stage Renal Disease (ESRD) Beneficiaries

CMS Internet-Only Manual, Pub 100-08, Medicare Program Integrity Manual, Chapter 13, §13.5.1 General Requirements

CMS Manual System, Pub 100-08, Medicare Program Integrity Manual, Transmittal 863, Change Request 10901, dated February 12, 2019

42 CFR §494.80 Condition: Patient assessment and §494.90 Condition: Patient plan of care

CMS Final Rule CMS-1651-F published November 4, 2016

CMS Ruling 95-1 (V) Acceptable Standards of Practice—Application

Coverage Guidance

Coverage Indications, Limitations, and/or Medical Necessity

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by this entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

Compliance with the provisions in this policy may be monitored and addressed through post payment data analysis and subsequent medical review audits.

History/Background and/or General Information

According to the Kidney Disease Outcomes Quality Initiative (KDOQI™) Practice Guideline for Hemodialysis Adequacy: 2015 update1, over 400,000 patients are currently treated with hemodialysis (HD) in the United States, with Medicare spending approaching $90,000 per year of care in 2012. They note mortality rates remain higher than age-matched individuals in the general population. They also experience an average of 2 hospitalizations per year.

The KDOQI™ 2015 Update1 states the following: Attempts to improve outcomes have included initiating dialysis at higher glomerular filtration rates (GFRs), increasing dialysis frequency and/or duration, using newer membranes, and employing supplemental or alternative hemofiltration. Efforts to increase the dose of dialysis administered 3 times weekly have not improved survival, indicating that something else needs to be addressed.

This guideline was also cited in the most recent CMS Final Rule CMS-1651-F published November 4, 2016.

Covered Indications

  1. Metabolic conditions (acidosis, hyperkalemia, hyperphosphatemia)
  2. Fluid positive status not controlled with routine dialysis
  3. Pregnancy
  4. Heart Failure
  5. Pericarditis
  6. Incomplete dialysis secondary to hypotension or access issues

Limitations

The following are considered not reasonable and necessary and therefore, will be denied as not medically justified for payments.

  1. Sessions furnished in excess of 3 sessions per week are not considered reasonable and necessary, unless fully supported in the medical documentation as detailed in this policy
  2. Planned inadequate or short dialysis
  3. Sessions performed for convenience of patient or staff

There are documentation requirements in this LCD, which if not followed will generate denials. Please refer to the Documentation Requirements section below.

While there are no set frequency limitations for these services, continued use of additional sessions by a given provider or for a given beneficiary or unusual patterns of billing, verification of need for services may generate reviews. Please refer to the Utilization Guidelines section below.

For coding guidelines, please refer to the related Billing and Coding: Frequency of Hemodialysis A55354 article.

Notice: Services performed for any given diagnosis must meet all of the indications and limitations stated in this policy and Billing and Coding: Frequency of Hemodialysis A55354 article; the general requirements for medical necessity as stated in CMS payment policy manuals; any and all existing CMS national coverage determinations; and all Medicare payment rules.

The redetermination process may be utilized for consideration of services performed outside of the reasonable and necessary requirements in this LCD.

HD at 3 times (3 X) per week is noted to be ‘conventional’ treatment. Conventional HD remains the most common treatment modality for end stage renal disease (ESRD) worldwide and is usually performed for 3 to 5 hours, 3 days per week. CMS established payment for hemodialysis based on conventional treatment.

Hence, Medicare reimburses HD treatments 3 times per week (13/14 sessions per month depending on length of month). In CMS-1651-F (November 4, 2016), CMS outlines the process for medical justification aspect of the overall requirements of being reasonable and necessary for additional treatment payments.

This LCD sets out medical conditions likely to meet reasonable and necessary requirements for additional payments.

ESRD facilities establish parameters for treatment of any given patient through a Patient Plan of Care (POC). It is defined in the Conditions of Coverage for ESRD Services 42 CFR 494.90. Among other items, the POC developed by the Interdisciplinary Team must provide the necessary care and services to manage the patient’s volume status; and achieve and sustain the prescribed dose of dialysis to meet a hemodialysis Kt/V of at least 1.2 and a peritoneal dialysis weekly Kt/V of at least 1.7, or meet an alternative equivalent professionally-accepted clinical practice standard for adequacy of dialysis.

The prescription for chronic hemodialysis therapies includes the type of dialysis access, the type and amount of anticoagulant to be employed, blood flow rates, dialysate flow rate, ultrafiltration rate, dialysate temperature, type of dialysate (acetate versus bicarbonate) and composition of the electrolytes in the dialysate, size of hemodialyzer (surface area) and composition of the dialyzer membrane (conventional versus high flux), duration and frequency of treatments, the type and frequency of measuring indices of clearance, and intradialytic medications to be administered.

Those treatment sessions furnished to the beneficiary are paid by Medicare as 3X per week. If more than 3 sessions per week are furnished, such as 4-6 sessions per week, Medicare will pay the 3X per week amount unless there is a covered indication, appropriate use of the KX modifier occurs, and it is supported by medical documentation. Refer to the related Billing and Coding: Frequency of Hemodialysis A55354 article for more information on appropriate use of the KX modifier.

However, on occasion, acute, and occasionally chronic, conditions may require additional sessions during the month. These may be considered for additional payment. The related Billing and Coding: Frequency of Hemodialysis A55354 article provides a list of diagnoses felt to be consistent with such clinical conditions that could establish reasonable and necessary requirements for payment. Use of these diagnoses should be verified in the medical records to support any payment made.

Clinical conditions not seen listed in this policy may still be appropriate to allow payment. However, these claims may require additional review through the appeals process.

Medicare will monitor the frequency of additional sessions which may trigger Medical Review.

The POC reassessment is noted in 42 CFR 494.80(d).

Please note the POC does not establish medical necessity by itself and will need to be supported by other medical documentation as outlined in the Documentation Requirements below.

Repeated need for additional dialysis sessions is expected to be addressed in the medical documentation and addressed in the subsequent POC, including attempts to correct any issues (see medical Documentation Requirements below).

This LCD establishes Documentation Requirements as listed in the appropriate section below. 

Summary of Evidence

KDOQI™ Clinical Practice Guideline for Hemodialysis Adequacy: 2015 Update, Guideline1 4.1.1 states to "Consider additional hemodialysis sessions or longer hemodialysis treatment times for patients with large weight gains, high ultrafiltration rates, poorly controlled blood pressure, difficulty achieving dry weight, or poor metabolic control (such as hyperphosphatemia, metabolic acidosis, and/or hyperkalemia)". This specific recommendation was ‘Not Graded’ in the Guidelines but based on expert opinions. However, these guidelines are determined by a panel of experts and are felt to have a STRONG level of evidence to follow.

While uncontrolled hypertension is noted to be an indication for additional dialysis frequency, the included diagnoses are felt to be adequate for the condition in lieu of an available ICD-10 diagnosis.

The Kidney Disease: Improving Global Outcomes (KDIGO) Guidelines2 for the evaluation and management of chronic kidney disease (CKD) address the many facets of CKD. The guidelines discuss the management variables that may affect CKD. Indications are supportive of guidelines above.

In the 2018 Seminars in Dialysis article, “When is more frequent hemodialysis beneficial?”, Suri and Kliger3 discuss the unresolved issue pertaining to frequency of dialysis. They review 3 randomized trials, 15 comparative cohort studies and some case series for recommendations and adverse events related to increased frequency of dialysis. They note effect on mortality remains controversial with conflicting results. More frequent dialysis is noted as being associated with vascular access site problems. Recommendations for increased frequency of dialysis include pregnant women, patients who are unable to obtain a dry weight on 3X per week regimen and for minimal urine output patients with left ventricular hypertrophy.

National experts were also contacted for input during development of this policy.

Analysis of Evidence (Rationale for Determination)

Based on KDOQI™ Practice Guidelines as well as KDIGO Guidelines, and the Suri and Kliger article, the listed conditions in the LCD may meet reasonable and necessary requirements for additional payments.

Based on local collaborative data, Medicare contractors expect the list of diagnoses in the related Billing and Coding: Frequency of Hemodialysis A55354 article would represent the great majority of claims for which additional payments may occur.

Facilities with sites in multiple states should be able to submit claims in a unified approach.

However, this LCD would not be the appropriate approach to change the payment methodology by CMS and reconsiderations to this LCD to potentially try to change the CMS payment process will be denied as invalid reconsideration to this LCD.

General Information

Associated Information

Documentation Requirements                                           

  1. The medical records documentation should include the order from the prescribing physician for the additional sessions.  This should be available for each and every additional session outside the usual 13/14 treatments per month with the CG modifier appended, as well as those described in this LCD with the KX modifier appended.  Should the records not show the order and evaluation leading to additional session, denials will occur.
  2. Documentation should be available on request and may include: the updated Plan of Care, documents from recent hospital care, office visits, dialysis progress notes, or monthly capitation payment (MCP) visits reflecting the clinician’s assessment and changes as indicated. Lack of this documentation will lead to denials

Utilization Guidelines

In accordance with CMS Ruling 95-1 (V), utilization of these services should be consistent with locally acceptable standards of practice.

With continued utilization of additional sessions by a specific provider generally, or for a given beneficiary, providers should expect medical review of medical records by contractors.

Sources of Information

Contractor is not responsible for the continued viability of websites listed.

Other Contractor's Policies:

Novitas Solutions, Inc., L35014 - Frequency of Dialysis

First Coast Service Options L33970 Frequency of Hemodialysis

Contractor Medical Director ESRD Workgroup

Bibliography
  1. National Kidney Foundation. KDOQI™ clinical practice guideline for hemodialysis adequacy: 2015 update. Am J Kidney Dis. 2015;66(5):884-930.
  2. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3(1):1-150.
  3. Suri RS, Kliger AS. When is more frequent hemodialysis beneficial? Semin Dial. 2018;31(4):332-342.
  4. American Journal of Kidney Diseases (AJKD). Intensive hemodialysis: Potential for improving outcomes. Am J Kidney Dis. 2016;68(5):Suppl 1: S1-S58.
  5. Assimon MM, Wenger JB, Wang L, Flythe JE. Ultrafiltration rate and mortality in maintenance hemodialysis patients. Am J Kidney Dis. 2016;68(6):911-922.
  6. Ayus JC, Achinger SG, Mizani MR, et al. Phosphorus balance and mineral metabolism with 3 h daily hemodialysis. Kidney Int. 2007;71(4):336-342.
  7. Ayus JC, Mizani MR, Achinger SG, Thadhani R, Go AS, Lee S. Effects of short daily versus conventional hemodialysis on left ventricular hypertrophy and inflammatory markers: A prospective, controlled study. J Am Soc Nephrol. 2005;16(9):2778-2788.
  8. Bansal N, McCulloch CE, Lin F, et al. Blood pressure and risk of cardiovascular events in patients on chronic hemodialysis: The CRIC Study (Chronic Renal Insufficiency Cohort). Hypertension. 2017;70(2):435-443.
  9. Banshodani M, Kawanishi H, Fukuma S, Moriishi M, Shintaku S, Tsuchiya S. The impact of hemodialysis schedules on the day of the week of hospitalization for cardiovascular and infectious diseases, over a period of 20 years. PLoS One. 2017;12(7):1-15.
  10. Buoncristiani U, Fagugli R, Ciao G, et al. Left ventricular hypertrophy in daily dialysis. Miner Electrolyte Metab. 1999;25(1-2):90-94.
  11. Chan CT, Chertow GM, Daugirdas JT, et al. Effects of daily hemodialysis on heart rate variability: Results from the frequent hemodialysis network (FHN) daily trial. Nephrol Dial Transplant. 2014;29(1):168-178.
  12. Chan CT, Floras JS, Miller JA, Richardson RM, Pierratos A. Regression of left ventricular hypertrophy after conversion to nocturnal hemodialysis. Kidney Int. 2002;61(6):2235-2239.
  13. Chan CT, Greene T, Chertow GM, et al. Determinants of left ventricular mass in patients on hemodialysis: Frequent hemodialysis network (FHN) trials. Circ Cardiovasc Imaging. 2012;5(2):251-261.
  14. Chazot C, Vo-Van C, Lorriaux C, et al. Even a moderate fluid removal rate during individualised haemodialysis session times is associated with decreased patient survival. Blood Purif. 2017;44(2):89-97.
  15. Chertow GM, Levin NW, Beck GJ, et al. In-center hemodialysis six times per week versus three times per week. N Engl J Med. 2010;363(24):2287-2300.
  16. Culleton BF. Introduction. Canadian society of nephrology clinical practice guidelines. J Am Soc Nephrol. 2006;17(3 Suppl 1):S1-S3.
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  18. Daugirdas JT, Chertow GM, Larive B, et al. Effects of frequent hemodialysis on measures of CKD mineral and bone disorder. J Am Soc Nephrol. 2012;23(4):727-738.
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  20. Finkelstein FO, Schiller B, Daoui R, et al. At-home short daily hemodialysis improves the long-term health-related quality of life. Kidney Int. 2012;82(5):561-569.
  21. Flythe JE, Assimon MM, Overman RA. Target weight achievement and ultrafiltration rate thresholds: Potential patient implications. BMC Nephrol. 2017;18(1);1-13.
  22. Garg AX, Suri RS, Eggers P, et al. Patients receiving frequent hemodialysis have better health-related quality of life compared to patients receiving conventional hemodialysis. Kidney Int. 2017;91(3):746-754.
  23. Hall YN, Larive B, Painter P, et al. Effects of six versus three times per week hemodialysis on physical performance, health, and functioning: Frequent hemodialysis network (FHN) randomized trials. Clin J Am Soc Nephrol. 2012;7(5):782-794.
  24. Hanly PJ, Pierratos A. Improvement of sleep apnea in patients with chronic renal failure who undergo nocturnal hemodialysis. N Engl J Med. 2001;344(2):102-107.
  25. Heidenheim AP, Muirhead N, Moist L, Lindsay RM. Patient quality of life on quotidian hemodialysis. Am J Kidney Dis. 2003;42(1Suppl):36-41.
  26. Hussein WF, Arramreddy R, Sun SJ, Reiterman M, Schiller B. Higher ultrafiltration rate is associated with longer dialysis recovery time in patients undergoing conventional hemodialysis. Am J Nephrol. 2017;46(1):3-10.
  27. Jaber BL, Lee Y, Collins AJ, et al. Effect of daily hemodialysis on depressive symptoms and postdialysis recovery time: Interim report from the FREEDOM (following rehabilitation, economics and everyday-dialysis outcome measurements) study. Am J Kidney Dis. 2010;56(3):531-539.
  28. Jaber BL, Schiller B, Burkart JM, et al. Impact of at-home short daily hemodialysis on restless legs symptoms and sleep disturbances. Clin J Am Soc Nephrol. 2011;6(5):1049-1056.
  29. Jefferies HJ, Virk B, Schiller B, Moran J, McIntyre CW. Frequent hemodialysis schedules are associated with reduced levels of dialysis induced cardiac injury (myocardial stunning). Clin J Am Soc Nephrol. 2011;6(6):1326-1332.
  30. Jindal K, Chan CT, Deziel C, et al. Canadian society of nephrology clinical practice guidelines. J Am Soc Nephrol. 2006;17(3 Suppl 1):S1-S27.
  31. Karpetas A, Loutradis C, Bikos A, et al. Blood pressure variability is increasing from the first to the second day of the interdialytic interval in hemodialysis patients. J Hypertens. 2017;35(12):2517-2526.
  32. Kennedy C, Ryan SA, Kane T, Costello RW, Conlon PJ. The impact of change of renal replacement therapy modality on sleep quality in patients with end stage renal disease: A systematic review and meta-analysis. J Nephrol. 2017;31(1):61-70.
  33. Kotanko P, Garg AX, Depner T, et al. Effects of frequent hemodialysis on blood pressure: Results from the randomized frequent hemodialysis network trials. Hemodial Int. 2015;19(3):386-401.
  34. Kraus M, Burkart J, Hegeman R, Solomon R, Coplon N, Moran J. A comparison of center-based vs. home-based daily hemodialysis for patients with end-stage renal disease. Hemodial Int. 2007;11(4):468-477.
  35. Laskin BL, Huang G, King E, et al. Short, frequent, 5-days-per-week, in-center hemodialysis versus 3-days-per week treatment: A randomized crossover pilot trial through the midwest pediatric nephrology consortium. Pediatr Nephrol. 2017;32(8):1423-1432.
  36. Lindsay RM, Heidenheim PA, Nesrallah G, et al. Minutes to recovery after a hemodialysis session: A simple health-related quality of life question that is reliable, valid, and sensitive to change. Clin J Am Soc Nephrol. 2006;1(5):952-959.
  37. Lockridge RS, Spencer M, Craft V, et al. Nightly home hemodialysis: Five and one-half years of experience in Lynchburg, Virginia. Hemodial Int. 2004;8(1):61-69.
  38. Mactier R, Hoenich N, Breen C. Renal association clinical practice guideline on haemodialysis. Nephron Clin Pract. 2011;118(Suppl 1):c241-c286.
  39. Manns BJ, Walsh MW, Culleton BF, et al. Nocturnal hemodialysis does not improve overall measures of quality of life compared to conventional hemodialysis. Kidney Int. 2008;75(5):542-549.
  40. Murashima M, Kumar D, Doyle AM, Glickman JD. Comparison of intradialytic blood pressure variability between conventional thrice-weekly hemodialysis and short daily hemodialysis. Hemodial Int. 2010;14(3):270-277.
  41. National Kidney Foundation. KDOQI™ clinical practice guideline for diabetes and CKD: 2012 update. Am J Kidney Dis. 2012;60(5):850-886.
  42. Painter P, Krasnoff JB, Kuskowski M, Frassetto L, Johansen K. Effects of modality change on health-related quality of life. Hemodial Int. 2012;16(3):377-386.
  43. Raimann JG, Chan CT, Daugirdas JT, et al. The effect of increased frequency of hemodialysis on volume-related outcomes: A secondary analysis of the frequent hemodialysis network trials. Blood Purif. 2016;41(4):277-286.
  44. Rocco MV, Lockridge RS, Beck GJ, et al. The effects of frequent nocturnal home hemodialysis: The frequent hemodialysis network nocturnal trial. Kidney Int. 2011;80(10):1-12.
  45. Sarafidis PA, Persu A, Agarwal R, et al. Hypertension in dialysis patients: A consensus document by the european renal and cardiovascular medicine (EURECA-m) working group of the european renal association - european dialysis and transplant association (ERA-EDTA) and the hypertension and the kidney working group of the european society of hypertension (ESH). J Hypertens. 2017;35(4):657-676.
  46. Silverstein DM. Frequent hemodialysis: History of the modality and assessment of outcomes. Pediatr Nephrol. 2017;32(8):1293-1300.
  47. Sirich TL, Fong K, Larive B, et al. Limited reduction in uremic solute concentrations with increased dialysis frequency and time in the frequent hemodialysis network daily trial. Kidney Int. 2017;91(5):1186-1192.
  48. Suri RS, Li L, Nesrallah GE. The risk of hospitalization and modality failure with home dialysis. Kidney Int. 2015;88(2):360-368.
  49. Tattersall J, Martin-Malo A, Pedrini L, et al. EBPG guideline on dialysis strategies. Nephrol Dial Transplant. 2007;22(Suppl 2):ii5-21.
  50. Thomson BK, Huang SH, Chan C, Urquhart B, Skanes A, Lindsay RM. Nocturnal home hemodialysis associates with improvement of electrocardiographic features linked to sudden cardiac death. ASAIO J. 2014;60(1):99-105.
  51. Ting GO, Kjellstrand C, Freitas T, Carrie BJ, Zarghamee S. Long-term study of high-comorbidity ESRD patients converted from conventional to short daily hemodialysis. Am J Kidney Dis. 2003;42(5):1020-1035.
  52. Unruh ML, Larive B, Chertow GM, et al. Effects of 6-times-weekly versus 3-times-weekly hemodialysis on depressive symptoms and self- reported mental health: Frequent hemodialysis network (FHN) trials. Am J Kidney Dis. 2013;61(5):748-758.
  53. Watanabe Y, Kawanishi H, Suzuki K, et al. Japanese society for dialysis therapy clinical guideline for "Maintenance hemodialysis: Hemodialysis prescriptions". Ther Apher Dial. 2015;19(Suppl 1):67-92.
  54. Weinhandl ED, Gilbertson DT, Collins AJ. Mortality, hospitalization, and technique failure in daily home hemodialysis and matched peritoneal dialysis patients: A matched cohort study. Am J Kidney Dis. 2016;67(1):98-110.
  55. Weinhandl ED, Liu J, Gilbertson DT, Arneson TJ, Collins AJ. Survival in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients. J Am Soc Nephrol. 2012;23(5):895-904.
  56. Weinhandl ED, Nieman KM, Gilbertson DT, Collins AJ. Hospitalization in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients. Am J Kidney Dis. 2015;65(1):98-108.
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Revision History Information

Revision History DateRevision History NumberRevision History ExplanationReasons for Change
12/10/2020 R11

Under CMS National Coverage Policy added regulations “CMS Final Rule CMS-1651-F published November 4, 2016” and “CMS Ruling 05-1 (V) Acceptable Standards of Practice—Application”. Under Associated Information subheading Documentation Requirements removed #1-#4 with corresponding verbiage and moved to related billing and coding article. KDOQI™ was added where applicable throughout the LCD. Formatting, punctuation and typographical errors were corrected throughout the LCD. Acronyms were inserted and defined where appropriate throughout the LCD.

At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

  • Provider Education/Guidance
10/01/2019 R10

This LCD is being revised in order to adhere to CMS requirements per Chapter 13, Section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs. There has been no change in coverage with this LCD revision. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of this LCD and placed in the related Billing and Coding: Frequency of Hemodialysis A55354 article.

At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

  • Provider Education/Guidance
07/01/2019 R9

LCD revised and published 07/04/2019 effective for dates of service on and after 07/01/2019 consistent with Change Request 10901 to remove language from CMS Internet Only Manuals (IOM) and/or regulations and list applicable manual/regulation reference and to remove all CPT® and ICD-10 diagnosis codes. IOM references have been updated and all codes have been placed in the related Billing and Coding: Frequency of Hemodialysis A55354 article. There will not be a lapse in coverage and there has been no change to the coverage content of this LCD.

At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

  • Other (Changes in response to CMS Change Request)
03/01/2019 R8

This LCD is being finalized as a national policy for consistency among jurisdictions.

  • Provider Education/Guidance
  • Creation of Uniform LCDs With Other MAC Jurisdiction
01/29/2018 R7 The Jurisdiction "J" Part A Contracts for Alabama (10111), Georgia (10211) and Tennessee (10311) are now being serviced by Palmetto GBA. The notice period for this LCD begins on 12/14/17 and ends on 01/28/18. Effective 01/29/18, these three contract numbers are being added to this LCD. No coverage, coding or other substantive changes (beyond the addition of the 3 Part A contract numbers) have been completed in this revision.
  • Change in Affiliated Contract Numbers
10/01/2017 R6

Under ICD-10 Codes That Support Medical Necessity added ICD-10 codes I50.810, I50.811, I50.812, I50.813, I50.814, I50.82, I50.83, I50.84 and I50.89. The code description was revised for I50.1. This revision is due to the 2017 Annual ICD-10 Updates.

At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy. 

  • Provider Education/Guidance
  • Revisions Due To ICD-10-CM Code Changes
03/16/2017 R5 Under CMS National Coverage Policy - Revisions made to Pub 100-03 Chapter 1 Part 2 Section 110.15; addition of manual title “Ultrafiltration Hemoperfusion and Hemofiltration”. Addition to manual title for Pub 100-04 Chapter 3 Section 100.6 to read “Inpatient Renal Services”.
Under Sources of Information and Basis for Decision- Revision to reference to add the issue number to article by Cooper Ba, Branley P, Bulfone L, et al. to read “2010; 363(7): 609-619.” Correction to authors for book, Brenner and Rector’s The Kidney, to read “Brenner BM, Rector FC.” Correction to add issue number to article “In-Center Hemodialysis Six Times Per Week Versus Three Times Per Week” to read “2010; 363(24):2287-2300.” Revision to reference to remove “2006 Updates”, and add the issue number (1).
  • Provider Education/Guidance
  • Typographical Error
10/01/2016 R4 Under ICD-10 Codes That Support Medical Necessity: Group 1 added O09.A0, O09.A1, O09.A2, O09.A3, O09.211, O09.212, O09.213 and O09.219.
  • Provider Education/Guidance
  • Revisions Due To ICD-10-CM Code Changes
03/10/2016 R3 Under CMS National Coverage Policy revised the verbiage for Title XVIII of the Social Security Act, §1833(e). Under Coverage Indications, Limitations and/or Medical Necessity-Hyperkalemia deleted “or” from the second sentence of the paragraph and revised “for” to now read “of”. Under Coverage Indications, Limitations and/or Medical Necessity-Volume Overload revised the verbiage in the paragraph for clarification. Under ICD-10 Codes That Support Medical Necessity added “an” to the paragraph regarding CPT code 90999. Under Sources of Information and Basis for Decision author initials were corrected, the year was corrected for the first cited source and the page number was corrected for the fourth cited source. The title was corrected for the second cited source.
  • Provider Education/Guidance
  • Other
10/01/2015 R2 Per CMS Internet-Only Manual, Pub 100-08, Medicare Program Integrity Manual, Chapter 13, §13.1.3 LCDs consist of only “reasonable and necessary” information. All bill type and revenue codes have been removed.
  • Other (Bill type and/or revenue code removal)
10/01/2015 R1 Under CMS National coverage Policy added references for pub 100-02, Chapter 11, sections 20.4 and 50; Pub 100-04, Chapter 3, section 100.6; Pub 100-03, Chapter 1, Part 2, Section 110.15 and Pub 100-04, Chapter 8, section 50.6.2.Under Sources of Information and basis for decision added source reference for In center hemodialysis six times a week versus 3 times per week.
  • Provider Education/Guidance
  • Other (annual validation)

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Keywords

  • Dialysis
  • Hemodialysis

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