2025 HCPCS code P96
(Valid) Effective Date: N/A Revision Date: N/A Medical and Surgical Supplies - Dialysis Services Feed
Dialysis services (non-Medicare fee schedule).
Modifiers may be applicable to P96 to indicate specific circumstances related to the dialysis service provided. Refer to HCPCS modifier guidelines for proper usage.
Medical necessity for dialysis is established by the patient's underlying kidney condition (ESRD or AKI) and the need for renal replacement therapy to maintain life or improve kidney function.The documentation must support the medical necessity of the dialysis treatment.
The clinical responsibility for dialysis services typically falls on nephrologists (kidney specialists) and dialysis nurses. They manage the dialysis process, monitor the patient's condition, and adjust the treatment as needed.
In simple words: This code is used for dialysis treatments when Medicare isn't paying.
This code represents dialysis services that are not covered under the Medicare fee schedule.It is used for billing purposes when dialysis services are provided in a non-Medicare context, such as for patients with private insurance or other payers.
Example 1: A patient with end-stage renal disease (ESRD) who is not eligible for Medicare receives dialysis treatments at a private dialysis center. Code P96 would be used for billing the private insurer., A patient with acute kidney injury (AKI) requires temporary dialysis during a hospitalization. If the patient is covered by private insurance, code P96 might be used for billing the dialysis services to the insurer., A patient with ESRD who has private insurance as primary and Medicare as secondary coverage receives dialysis. Code P96 might be used to bill the private insurance for any services not covered by Medicare.
Documentation for P96 should include details of the dialysis treatment, such as the type of dialysis (hemodialysis or peritoneal dialysis), the duration of the treatment, any complications encountered, and the patient's response to the treatment.
** It's important to differentiate P96 from other dialysis-related HCPCS codes and ensure it is used only in appropriate non-Medicare billing scenarios. Always verify payer-specific guidelines for dialysis service billing and coding.
- Payment Status: Active
- Specialties:Nephrology
- Place of Service:"Office", "Home", "Inpatient Hospital", "Independent Clinic", "End-Stage Renal Disease Treatment Facility"