Instructions for Billing of Monthly Home Dialysis MCP services

Effective January 1, 2011, the MCP (Monthly Capitation Payment) physician (or practitioner) must furnish at least one face-to-face patient visit per month for the home dialysis MCP service as described by CPT codes 90963, 90964, 90965, and 90966 shown in the following table. 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 that the physician actively and adequately managed the care of the home dialysis patient throughout the month.

When billing MCP services for a home dialysis patient who remained on home dialysis the entire month including at least one face-to-face visit, use the appropriate code from this series:

90963 End-stage renal disease (ESRD) related services for home dialysis per full month, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents

90964 End-stage renal disease (ESRD) related services for home dialysis per full month, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents

90965 End-stage renal disease (ESRD) related services for home dialysis per full month, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents

90966 End-stage renal disease (ESRD) related services for home dialysis per full month, for patients 20 years of age and older

Reference: http://www.cms.gov/MLNMattersArticles/downloads/MM7003.pdf