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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 9 Physician : 9.2 Services, Benefits, Limitations, and Prior Authorization : 9.2.64 Renal Disease : Self-Dialysis Patients
Physician reimbursement for supervision of patients on self-dialysis is made after completion of the patient’s training. If the training is not completed, payment is proportionate to the amount of time spent in training. Payment for training may be made in addition to payment under the MCP for physician supervision of an in-facility maintenance dialysis patient. Use procedure codes 90989 and 90993 for dialysis training regardless of the type of training performed. These procedure codes must be billed as specified:
When complete dialysis training is provided, bill procedure code 90989. Providers are to use modifier AT when using this procedure code. The date of service indicates the date training was completed, and the quantity is 1.
When dialysis training is not completed, bill procedure code 90993. The date of service must list each day that a session of training was provided and the quantity must indicate the number of training sessions provided.
The amount of reimbursement of subsequent training is determined by prorating the physician’s payment for initial training sessions. The amount of payment for each additional training session does not exceed $20.
All physician services required to create the capacity for self-dialysis must include:
The following services are included in the physician charge for supervision of a client on self-dialysis:
Physician services rendered by the attending physician in the course of an office visit, the primary purpose of which is routine monitoring or the follow-up of complications of dialysis, including services involved in prescribing therapy for illnesses unrelated to renal disease, which may be appropriately treated without increasing the number of contacts beyond those occurring at regular monitoring sessions or visits for treatment of renal complications.
No additional payment is made after the initial self-dialysis training course unless subsequent training is required for one of the following reasons:
The physician must document the reason for additional training sessions on the CMS-1500 paper claim form.
Dialysis equipment and supplies used by the client who dialyzes in the home are not benefits of Texas Medicaid, including the lease or purchase of dialysis machines and disposable supply kits.

Texas Medicaid & Healthcare Partnership
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