Page 289 - Medicare Benefit Policy Manual

• hospital, critical access hospital (CAH), skilled nursing facility (SNF),
comprehensive outpatient rehabilitation facility (CORF), home health agency
(HHA), or hospice, if the KDE services are provided in a rural area (using the
actual geographic location core based statistical area (CBSA) to identify facilities
located in rural areas), or

• hospital or CAH that is treated as being rural (was reclassified from urban to rural
status per 42 CFR 412.103).

NOTE: The “incident to” requirements at section 1861(s)(2)(A) of the Social Security
Act (the Act) do not apply to KDE services.

The following providers are not ‘qualified persons’ and are excluded from furnishing
KDE services:

• A hospital, CAH, SNF, CORF, HHA, or hospice located outside of a rural area
(using the actual geographic location CBSA to identify facilities located outside
of a rural area), unless the services are furnished by a hospital or CAH that is
treated as being in a rural area; and

• Renal dialysis facilities.

310.3 - Limitations for Coverage
(Rev. 194, Issued: 09-03-14, Effective: Upon Implementation of ICD-10,
Implementation: Upon Implementation of ICD-10)

Medicare Part B covers KDE services:

• Up to six (6) sessions as a beneficiary lifetime maximum. A session is 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.

• On an individual basis or in group settings; if the services are provided in a group
setting, a group consists of 2 to 20 individuals who need not all be Medicare
beneficiaries.

NOTE: Two HCPCS codes were created for this benefit and one or the other must be
present, along with the appropriate ICD diagnosis codes.

The diagnosis codes are:

• ICD-9-CM - code 585.4 (chronic kidney disease, Stage IV (severe)), or

• ICD-10-CM - code N18.4 (chronic kidney disease, Stage IV).