Acute Kidney Injury (AKI) Claims

40 - Acute Kidney Injury (AKI) Claims (Rev. 13740; Issued: 04-17-26; Effective: 07-01-26; Implementation: 07-06-26) Effective January 1, 2017, ESRD facilities, both hospital based and freestanding are able to furnish dialysis to AKI patients and receive payment under the ESRD PPS. Medicare will pay ESRD facilities for the dialysis treatment using the ESRD PPS base rate adjusted by the applicable ESRD PPS wage index. In addition to the dialysis treatment, the ESRD PPS base rate pays ESRD facilities for other items and services considered to be renal dialysis services as defined in 42 CFR §413.171. No separate payment is made for those services considered to be renal dialysis services as payment is included in the ESRD PPS base rate. Other items and services that are furnished to beneficiaries with AKI that are not considered to be renal dialysis services but are related to their dialysis as a result of their AKI, would be separately payable, this includes drugs, biologicals, laboratory services, and supplies that ESRD facilities are certified to furnish and that would otherwise be furnished to a beneficiary with AKI in a hospital outpatient setting. AKI claims are billed on the 072X type of bill with condition code 84. ESRD facilities are required to include revenue code 082X, 083x, or 088x for the modality of dialysis furnished with the Current Procedural Terminology (CPT) code G0491 (Dialysis procedure at a Medicare certified ESRD facility for Acute Kidney Injury without ESRD). AKI claims do not receive payment adjustments for comorbidities, TDAPA, TPNIES or outlier. When applicable, AKI claims receive the home dialysis training add-on payment adjustment (see section 50.8). The ESRD network reduction is not applicable to AKI claims. Reporting additional condition codes: • Effective January 1, 2025, AKI claims for dialysis in the home setting must also include condition code 74. • Effective January 1, 2025, AKI claims for training or re-training for AKI home and self-dialysis must also include either condition code 73 or 87 as appropriate. • Effective July 1, 2025, AKI claims for home dialysis patients who require an in- center back-up dialysis treatment may also include condition code 76. More information on dialysis provided for AKI patients including the required diagnosis codes for billing AKI is available on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ESRDpayment/AKI- and-ESRD-Facilities.