Outlined below are generally accepted billing guidelines. This is intended to be illustrative and is not an all-inclusive list.
• Indicate “72X” type of bill. The third digit is based on the type of claim (interim, corrected, etc.).
• Hospital inpatient dialysis departments should bill with their hospital provider number and will be paid under the hospital agreement.
• Bill one claim per calendar month except when training is provided or when hemodialysis is performed in the same month as peritoneal dialysis.
• Do not submit claims that cross over from one month to the other. For example, service dates in January should be on one claim and service dates in February should be on another claim.
• Bill a line item date of service for each revenue code billed on the claim form.
• Revenue codes should be listed in ascending numeric order by date of service and line item billed.
• Bill a separate line item for each dialysis session performed.
• Separately billable drugs, including EPO should be line item billed. Include the line item date of service for the administration. Reimbursement will be calculated based on the units reported on the line.
• The units reported on the line for each date dialysis (codes 821, 831, 841 and 851) was performed should not exceed one.
• Height and weight should be reported for all ESRD patients.
• A8 – Weight in kilograms
• A9 – Height in centimeters
• Report modifiers, occurrence codes, and condition codes.
• Bill must include revenue codes and CPT codes for each line of service. For example, when billing hemodialysis submit revenue code 0821 with CPT code 90999.
• The training rate includes the composite rate. Therefore, the composite rate should not be billed separately for days when training was provided.
• Do not bill for hemodialysis and peritoneal dialysis composite rates on the same claim. In this situation, you must bill a claim for each type of dialysis provided within the same calendar month. Dates of service must not overlap.
Non-contracted Medicare Advantage
The following fields are required on all Medicare Advantage claims:
• A patient’s height and weight – entered in the value amount fields for value codes A8 and A9
• CBSA – must be included in the value amount field for value code 61