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HCPCS Edits for Dialysis

Published on 

Tuesday, October 2, 2012

 | Outpatient Services 

Edits for outpatient ESRD dialysis HCPCS code G0257 went into effect October 1, 2012. See MLN Matters Article MM7762. Claims will be returned if G0257 is reported on a Type of Bill (TOB) other than 13x or 85x.

 

  • HCPCS code G0257 should only be reported for dialysis performed on hospital outpatients who have ESRD (TOB 13X or 85X) that meet the criteria as described in the Medicare Claims Processing manual, chapter 4, section 200.2.
  • CPT code 90935 is reported for:
  • Part B services (TOB 12x) for dialysis for hospital inpatients (with or without ESRD) who do not have Part A coverage, and for
  • hemodialysis performed on non-ESRD hospital outpatients (TOB 13x or 85x).
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This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.