Provider Notification: Dialysis Payment Policy

Date: 04/18/23

Dear Provider, 

Thank you for your continued partnership with Ambetter from Absolute Total Care. As you know, we are committed to continuously evaluating and improving overall Payment Integrity solutions as required by State and Federal governing entities. We are writing today to inform you of new policies Ambetter from Absolute Total Care will be implementing effective on or after 06/01/2023.
 

Policy Name	Description	Lines of Business
Dialysis Payment Policy	Based on CMS guidelines, hemodialysis service (90999) hemodialysis (CPT 90999) will be denied when a modifier (G1-G6) is not present on the claim. Interim claim bill type ending in XX2 or XX3 will be denied when discharge status 30 is not present on the claim.   Medicare Claims Processing Manual – Chapter 1, Chapter 8	Marketplace

 
If you have any questions about this or any of our payment policies, please don’t hesitate to reach out to our Provider Services team at 1-833-270-5443. Thank you for your continued participation and cooperation in our ongoing efforts to render quality health care to our members. We look forward to helping you provide the highest quality of care for our members.

Sincerely,

Ambetter from Absolute Total Care