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CodeMap® LCD-L34575


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LCD for Frequency of Hemodialysis (L34575)
See related Articles:
A55354-Billing and Coding: Frequency of Hemodialysis
A56215-Response to Comments: Frequency of Hemodialysis

Contractor Information

Contractor Name: Palmetto GBA - Full list of policies of this Medicare Contractor

Contractor Number: 11201

Contractor Type: MAC A

LCD Information

LCD ID Number: L34575 Status: A-Approved

LCD Title: Frequency of Hemodialysis

Geographic Jurisdiction: South Carolina Other Jurisdictions

Original Determination Effective Date: 10/01/2015

Original Determination Ending Date:

Revision Effective Date: 12/10/2020

Revision End Date:

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

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12/08/2022 01:07:34

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