Medicare Billing Rules for cpt code 90966

Hello, Can we bill cpt code 90966 twice in a month for medicare

CPT 90966 is the code a physician would use to bill Medicare for ESRD-related services for home dialysis per full month, for patients 20 years of age or older. Therefore, this code can only be used once per patient per month. Using this code, the physician should receive the Medicare monthly capitated payment rate equivalent to 2-3 visits for an in-center HD patient.

The CPT codes for physician billing for home dialysis patients can be found in the Medicare FAQs:

Should 90966 be billed with POS 11 or POS 12 by the physician? The patients generally come 1-2 times a month for the face-to-face service and dialysis is provided in the home.

The nephrologist would use the code 90966 to bill Medicare for the monthly capitation payment if the patient is 20+. The other codes are listed above. If the physician sees the patient at his/her office, the code would be 11. If the physician is seeing the patient at the dialysis facility, the code would be 65. This manual provides the place of service codes and instructions for billing on the CMS 1500 form.

Hello Beth - Just to confirm - we can see PD patients in the office POS 11 with CPT code 90966 - correct?

As I understand it, the place of service and procedure codes have not changed. The Renal Physicians Association has resources for coding and billing for physicians. You might want to check those out.

Thank you - I was just wanting to confirm that 90966 can be billed in POS 11 - we do bill 65 as we see them at the dialysis clinic

Below is a link to POS codes from HHS. he POC code is 11 if the physician sees the patient in his/her office. If the physician sees the patient in the dialysis facility, the POS code would be 65. After the first 3 months of home dialysis during which patients are supposed to have face-to-face visits with the physician, they can be seen by telehealth two out of every three months in a quarter. So, if the physician sees the patient by telehealth in their private residence, the POS code would be 10.