New modifier for Hemodialysis.
Hemodialysis is typically furnished three times per week in sessions of three to five hours duration, according to Medicare policy. For a 30-day month, payment is limited to 13 treatments and for a 31-day month, payment is limited to 14 treatments.
Append Modifier CG, policy criteria apply to the claim line for the date of service associated with the excess treatment that does not meet medical justification requirements, as defined by the Medicare administrative contractor (MAC), effective Oct. 1, 2017.
Newly issued modifier CG indicates that the facility attests the additional treatment does not meet justification requirements and should not be paid separately under the End Stage Renal Disease Prospective Payment System (ESRD PPS).
This modifier applies to the 72x type of bill with revenue code 0821 or 0881 and CPT code 90999 Unlisted dialysis procedure, inpatient or outpatient.
Extra hemodialysis sessions may be covered in a month if the service is ascertained by a licensed healthcare professional acting within his or her scope of practice. In addition, there must be a physician?s order for these medically necessary additional sessions. This must be documented in the medical record and made available to Medicare upon request.
The medically necessary extra HD sessions must be indicated on the claim form with the use of the CPT code 90999 and modifier KX Specific required documentation on file; and documentation related to these additional sessions must show appropriate medical justification as outlined in the MAC?s policy.