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.