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Lorraine Posted 3 Year(s) ago

We've billed dialysis training to Medicare Part B in the past and have received payment. In recent months, CPT 90989 is being denied by Medicare stating "Not paid to practitioner when provided to patient in this place of service. Payment included in the reimbursement to the facility". We are a private nephrology practice, not paid by a facility or hospital. Our claims reflect our providers as the servicing providers, place of service is the facility where services were rendered, not our office. Why are our claims being denied all of a sudden? About this Question - See more at:

SuperCoder Posted 3 Year(s) ago

As per Medicare, “90989 – Dialysis training, any mode, course completed”-
1. Need to be billed with place of service 65 (End-Stage Renal Disease Treatment Facility - A facility other than a hospital, which provides dialysis treatment, maintenance, and/or training to patients or caregivers on an ambulatory or home-care basis) on a professional claim.
2. The facility should be certified by Medicare.
3. The date of service should be the date when training is completed.
4. It can be billed only once per patient.
5. All people with Medicare with ESRD are covered.

Medicare Part B covers training if you're a candidate for home dialysis, as well as training conducted during the course of your regular treatments for you and the person helping you with your home dialysis treatments. The training must be conducted by a dialysis facility that has been certified by Medicare to provide home dialysis training. Only dialysis facilities can bill Medicare (directly or under arrangement) for providing home dialysis training.

Hope it helps answer your query.

Lorraine Posted 3 Year(s) ago

Thank you. It appears providers are no longer eligible to bill for their involvement in the training.

SuperCoder Posted 3 Year(s) ago

You are welcome.

Posted by Lorraine , 3 Year(s). There are 4 posts. The latest reply is from SuperCoder.

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