Hospital Dialysis Services for Patients with and without End Stage Renal Disease (ESRD)
Hospitals have been billing CMS on a 12x claim for acute dialysis services (those not covered and paid under the end stage renal disease (ESRD) benefit in 42 CFR 413.174) furnished to hospital inpatients with ESRD, using HCPCS code G0257 (Unscheduled or emergency dialysis treatment for an ESRD patient in a hospital outpatient department that is not certified as an ESRD facility). While Medicare covers these services under the Outpatient Prospective Payment System, hospitals should instead be reporting them under HCPCS code 90935 (Hemodialysis procedure with single physician evaluation). G0257, by definition, is reserved for outpatients with ESRD and should be used only when thecriteria specified in the Medicare Claims Processing Manual 100-04, Chapter 4, section 200.2 are met. Questions also have arisen regarding how hospitals should report dialysis for outpatients who do not have ESRD but who need hemodialysis treatment, so we are clarifying how those services should be billed.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: April 26, 2012
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