Forum - Questions & Answers

Dec 30th, 2011 - sreshta 45 

Home Dialysis Billing For Medicare

Hello, i have a question regarding billing CPT® code 90966 to medicare. My provider has done home dialysis (CPT® code 90966 -home diaysis monthly code) for a patient at two different locations, one is in dialysis place and the other is when the patient visited for check-up at clinic as required. My question is can we bill CPT® 90966 two times in a month to medicare with different place of services (POS:65 and 11). Any help would be greatly appreciated.
Thanks

Dec 30th, 2011 - nmaguire   2,606 

re: Home Dialysis Billing For Medicare

End Stage Renal Disease (ESRD)-related services for home dialysis per full month; for patients 20 years of age and older. Physicians and practitioners managing ESRD patients who dialyze at home are paid a single monthly rate based on the age of the beneficiary. Effective January 1, 2011, the MCP physician (or practitioner) must furnish at least one face-to-face patient visit per month for the home dialysis MCP service. Documentation by the MCP physician (or practitioner) should support at least one face-to-face encounter per month with the home dialysis patient. However, Medicare contractors may waive the requirement for a monthly face-to-face visit for the home dialysis MCP service on a case-by-case basis, for example, when the nephrologist’s notes indicate the physician actively and adequately managed the care of the home dialysis patient throughout the month. Do not bill 90966 twice in one month.The management of home dialysis patients who remain home dialysis patients the entire month should be coded using the ESRD-related services for home dialysis patient codes.
http://www.cms.gov/transmittals/downloads/R1999CP.pdf

Jan 1st, 2012 - sreshta 45 

re: Home Dialysis Billing For Medicare

Thanks Nancy



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