2025 HCPCS code G9013
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Procedures - Medicare Demonstration Projects Procedures / Professional Services Feed
This HCPCS code reports an end-stage renal disease (ESRD) demonstration project basic bundle level one service.
Modifiers may be applicable depending on the circumstances of service; consult current modifier guidelines.
Medical necessity must be established according to the guidelines of the specific ESRD demonstration project and payer.Documentation should demonstrate the patient's ESRD diagnosis and the need for the included services.
The provider reporting this code is responsible for delivering the basic bundle of services associated with an ESRD demonstration project.
In simple words: This code is for a special program that helps people with severe kidney disease.It covers the basic costs of treatment, including dialysis and medicine.
HCPCS code G9013 reports an ESRD demonstration project basic bundle level one service.ESRD refers to the final stage of kidney failure requiring dialysis or transplant due to irreversible loss of renal function. The Centers for Medicare & Medicaid Services (CMS) uses a composite payment rate (part of the ESRD bundle) for outpatient maintenance dialysis services for ESRD beneficiaries. This bundle includes dialysis treatments, lab tests, and injectable/oral medications (e.g., Epoetin alfa, iron, vitamin D).
Example 1: A nephrologist provides an ESRD demonstration project basic bundle level one service to a patient undergoing hemodialysis., A dialysis center reports the basic bundle level one service for a patient receiving peritoneal dialysis as part of an ESRD demonstration project., A home healthcare agency documents and reports the basic bundle level one service as part of an ESRD demonstration project for a patient receiving home hemodialysis.
Detailed documentation supporting the medical necessity of the services included in the ESRD demonstration project basic bundle, including patient demographics, diagnosis, treatment plan, and all services provided.
** This code is not reimbursable by Medicare.Specific details on the included services and reimbursement methodology vary depending on the specific ESRD demonstration project.
- Revenue Code: Information not available in source.
- RVU: Information not available in source.This would depend on the specific Medicare demonstration project and payment system.
- Global Days : Not applicable; this code represents a bundled service, not a surgical procedure with a global period.
- Payment Status: Not payable by Medicare.
- Modifier TC rule: Not applicable to this bundled service code.
- Fee Schedule : Information not available in source.
- Specialties:Nephrology
- Place of Service:Office, Outpatient Hospital, Dialysis Center, Home Health Agency