Dialysis

Dialysis services billing must be on a UB04 claim form. All dialysis claims and services must be submitted once per month and include services rendered during that month. Bill one date of service and one unit per line. 

The rates specified in the provider contract for the covered services listed are an all-inclusive, per-treatment rate including drugs, immunizations and any other services. Any drugs, immunizations or other services will not be separately reimbursable. If more than one code is billed on any given day, the higher dollar allowance will be paid.      

Use valid and acceptable revenue codes to assess the charge for dialysis services. 

Hemodialysis 

For hemodialysis services, providers may bill up to three times per week. If it is necessary to dialyze the patient more than three times per week, then appropriate documentation of the medical rationale in the medical record must be submitted with the claim and the claim will be reviewed for medical necessity. Blue Cross and Blue Shield of Nebraska or the applicable Blue Plan will determine whether services are medically necessary. Services will not automatically be considered medically necessary because they have been ordered or provided by a health care provider. If medical rationale is not provided, the claim will be denied.  

Peritoneal Dialysis

Continuous Ambulatory Peritoneal Dialysis (CAPD): Variation of peritoneal dialysis where peritoneal membrane is used as a filter. CAPD is generally done several times per day, requiring a bag of solution attached to the peritoneal catheter. The solution is left in the peritoneal cavity to exchange toxins, then drained. This occurs three to four times during the day and takes 30-40 minutes for each exchange.     

Continuous Cycler-assisted Peritoneal Dialysis (CCPD): Peritoneal dialysis requires a machine called a cycler to fill and drain the abdomen three to four times, usually during sleep.

For peritoneal dialysis services (both CAPD and CCPD), providers may bill appropriate CPT Code according to the provider contract.