Billing Requirements for Coverage of Kidney Disease Patient Education Services

20 – Billing Requirements for Coverage of Kidney Disease Patient Education Services (Rev. 1876; Issued: 12-18-09; Effective Date: 01-01-10; Implementation Date: 04-05-10) Effective for claims with dates of service on and after January 1, 2010, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) determines that kidney disease patient education services are covered when provided to patients with stage IV chronic kidney disease (CKD). See Pub. 100-02, chapter 15, section 310, for complete coverage guidelines. Contractors shall pay for kidney disease education (KDE) services that meet the following conditions: • No more than 6 sessions of KDE services are provided in a lifetime, • Is provided in increments of 1 hour. In order to bill for a session, a session must be at least 31 minutes in duration. A session that lasts at least 31 minutes, but less than 1 hour still constitutes 1 session. • Is provided either individually or in a group setting of 2 to 20 individuals who need not all be Medicare beneficiaries. • Furnished, upon the referral of the physician managing the beneficiary’s kidney condition, by a qualified person meaning a: o physician, physician’s assistant, nurse practitioner, or clinical nurse specialist; o hospital, critical access hospital (CAH), skilled nursing facility (SNF), comprehensive outpatient rehabilitation facility (CORF), home health agency (HHA), or hospice, that is located in a rural area, or o hospital or CAH that is paid as if it were located in a rural area (hospital or CAH reclassified as rural under section 42 CFR 412.103). NOTE: A renal dialysis facility (Type of Bill (TOB) 72x) is precluded from providing KDE services.