Ultrafiltration Coverage, Coding, and Reimbursement - JF Part A
Ultrafiltration Coverage, Coding, and Reimbursement
Ultrafiltration and ultrafiltration monitoring as a component of hemodialysis has an established and critical role in maintaining the well-being of End Stage Renal Disease (ESRD) patients and is a covered service. Ultrafiltration is the process of removing excess fluid from the blood of dialysis patients by using a dialysis machine without the dialysis solution, by means of pressure. It is not a substitute for dialysis. No separate payment when ultrafiltration is performed the same day as the dialysis treatment.
Ultrafiltration can be covered separately when medical complications make it necessary to provide the service at a time other than with a dialysis treatment. In these cases, documentation should include an explanation of why the ultrafiltration could not have been performed at the time of the dialysis treatment. ESRD facility will receive the ESRD PPS base rate.
Need may vary for pre-dialysis ultrafiltration; however, no additional charge will be reimbursed. The facilities rate covers the full range of complicated and uncomplicated outpatient dialysis treatments.
Billing Separate Ultrafiltration
- Type of Bill 072x
- Revenue code (RC) 0881 for ultrafiltration
- RC 082X, 083X, 084X, or 085X cannot appear on the same claim
- Units of service
- Appropriate HCPCS/CPT 90999
- Applicable value codes and amounts
- Applicable condition codes
- Diagnosis code (for medical justification)
- Appropriate modifier, when necessary
- Modifier CG (line item does not meet medical justification)
- Modifier KX (for medical justification)
Frequency of sessions apply:
- In-facility - three per week; Home - Maximum of three per week, regardless of frequency
- CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 8, Section 50.7 - Ultrafiltration
- CMS Ultrafiltration, Hemoperfusion and Hemofiltration (110.15) National Coverage Determination (NCD)