LCD ID Number: L37564 Status: A-Approved
LCD Title: Frequency of Hemodialysis
Geographic Jurisdiction: Puerto Rico, Virgin Islands Other Jurisdictions
Original Determination Effective Date:
03/01/2019
Original Determination Ending Date:
Revision Effective Date:
07/01/2019
Revision End Date:
CMS National Coverage Policy:
This 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 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 CMS manual instructions and policies may be found in the following Internet-Only Manuals (IOMs) published on the CMS Web site:
Internet Only Manual (IOM) Citations
- CMS IOM Publication 100-01, Medicare General Information, Eligibility, and Entitlement Manual
- Chapter 1, Section 10 General Program Benefits
- Chapter 2, Section 10 Hospital Insurance Entitlement
- CMS IOM Publication 100-02, Medicare Benefit Policy Manual
- Chapter 11, End Stage Renal Disease (ESRD)
- CMS IOM Publication 100-03, Medicare National Coverage Determination (NCD) Manual
- Chapter 1 Part 2, Section 110.10 Intravenous Iron Therapy; Section 110.15 Ultrafiltration, Hemoperfusion, Hemofiltration
- Chapter 1 Part 4, Section 260.6 Dental Exam prior to Kidney Transplantation
- CMS IOM Publication 100-04, Medicare Claims Processing Manual
- Chapter 8 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 IOM Publication 100-05, Medicare Secondary Payer Manual
- Chapter 2, Section 20 Medicare Secondary Payer Provisions for End Stage Renal Disease (ESRD) Beneficiaries
- CMS IOM Publication 100-08, Medicare Program Integrity Manual
- Chapter 13, Section 13.5.4 Reasonable and Necessary Provisions in an LCD
Change Requests references:
Change Request 5039, Transmittal 1084, October 27, 2006: Line Item Billing Requirement for End Stage Renal Disease (ESRD) Claims.
Change Request 9989, Transmittal 1849, May 12, 2017: Implementation of Modifier CG for Type of Bill 72X.
Change Request 10901, Transmittal 863, February 12, 2019: Local Coverage Determinations (LCDs)
Social Security Act (Title XVIII) Standard References:
Federal Register References:
42 CFR, Chapter IV, Subchapter G, Part 494, Subpart C,
• Section 494.80 Condition: Patient assessment.
• Section 494.90 Condition: Patient plan of care.
CMS Final Rule CMS-1651-F published November 4, 2016.
Note: Italicized font represents CMS manual titles, journal titles and/or CMS national NCD language/wording copied directly from CMS Manuals or CMS Transmittals. Contractors are prohibited from changing national NCD language/wording.
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