Home dialysis billing: peritoneal dialysis and home hemodialysis codes.
Home dialysis billing runs on the same age-banded MCP codes whether the modality is peritoneal dialysis or home hemodialysis — but the training billing, the catheter and access coding, the equipment benefit, and the one genuinely unresolved telehealth question underneath it are where the real revenue and audit risk sit. This guide goes past the code list and into the documentation, the caps, and the specific coverage rule most billing guides skip: what Medicare will and won't pay for a home dialysis patient's water treatment system.
Key takeaways
- 90963–90966 don't split by modality. PD and home hemodialysis share the same age-banded monthly codes; what has to match the modality is the visit note's clinical content, not the code.
- Training is billed separately, and the session cap differs by modality — industry sources put peritoneal dialysis training at up to 15 sessions and hemodialysis training at up to 25, under CPT 90989/90993.
- Home dialysis equipment isn't standard DME. It routes through the Home Dialysis Supplies and Equipment benefit, and water softening systems are specifically excluded from coverage except to pretreat water for a reverse-osmosis unit (NCD 230.7).
- The 90966 telehealth modifier question has no national answer. It's MAC-specific and payer-specific; treat it as a call-your-contractor item, not a rule you can copy from another region.
The MCP codes: one code family, two modalities
Home dialysis monthly management bills under the same four age-banded codes regardless of whether the patient is on peritoneal dialysis or home hemodialysis. There's no PD-specific or HHD-specific version of the monthly capitation code — the split is by age band for a full calendar month, and by the less-than-full-month codes when management doesn't span the whole month.
| Age band | Full month | Less than full month (per day) |
|---|---|---|
| Younger than 2 years | 90963 | 90967 |
| 2 through 11 years | 90964 | 90968 |
| 12 through 19 years | 90965 | 90969 |
| 20 years and older | 90966 | 90970 |
The less-than-full-month codes matter more in home dialysis than in-facility care, because the trigger is usually a modality transition rather than a transfer between physicians: a patient completing PD or HHD training mid-month, a temporary return to in-center hemodialysis after a peritonitis episode, or a mid-month death or transplant. Report the actual From and To dates managed under that modality, with per-day units matching the span — not a flat monthly unit forced onto a partial period.
The same visit-content requirements that apply to in-facility MCP billing apply here: a documented face-to-face assessment covering access status, fluid and volume status, nutritional status, dialysis adequacy, and an updated plan of care. What changes is which access the note references. A PD chart that discusses "vascular access" instead of the peritoneal catheter and exchange pattern, or an HHD chart that never mentions the vascular access at all, reads as a templated note on audit even when the code itself is correct.
Training codes: 90989 and 90993, and the caps that differ by modality
Patient (and helper, where applicable) training for home dialysis is billed under a separate pair of codes from the monthly management codes, reported in industry coding references as 90989 — dialysis training, completed course — and 90993 — dialysis training, per session, course not completed. ⚠️ These descriptors are paraphrased from AAPC's Codify reference and were not independently confirmed against the AMA's CPT Professional edition this session, since no CPT connector exists.
The session cap is where the two modalities genuinely diverge, and it's a detail most nephrology billing guides skip past. Multiple independent industry sources — AAPC's dialysis CPT range guide and a Medicare Administrative Contractor's own ESRD quick-reference manual, corroborated by additional billing-education publishers — report that Medicare pays for up to 15 training sessions for peritoneal dialysis and up to 25 for home hemodialysis. ⚠️ This build could not open a primary CMS source to confirm those two numbers directly (CMS.gov returned an access error to automated fetch); confirm against your MAC's current ESRD billing guidance before building a hard stop into a scheduling workflow around either number.
Documentation has to track the training log exactly. Bill 90989 only once the course is actually complete and the patient (and caregiver, where applicable) is ready for independent home management — billing it before training concludes creates a mismatch a payer can catch against the session log. Bill 90993 once per qualifying session as training progresses, with the specific date of each session; billing it indefinitely without ever closing the course out with 90989 invites a medical-necessity question about why training hasn't converted to independent management.
Track PD and HHD training sessions against their caps separately, not one shared counter. A counter that doesn't distinguish PD's lower cap from HHD's higher one will either under-bill a hemodialysis patient's legitimate sessions or push a PD patient past what's typically payable.
Peritoneal dialysis catheter placement and complications
PD access is a tunneled intraperitoneal catheter, placed either percutaneously or through an open approach — catheter billing, not the fistula or graft billing covered in our dialysis vascular access guide. Industry coding references describe two primary placement codes: percutaneous tunneled intraperitoneal catheter insertion (with imaging guidance and radiological supervision and interpretation), and open surgical tunneled intraperitoneal catheter insertion. ⚠️ Paraphrased from secondary coding references (AAPC Codify), not independently confirmed against the CPT Professional edition this session; the same descriptor family also covers non-dialysis uses (chemotherapy instillation, ascites management), which is easy to cross with dialysis placement in error, so verify before billing.
Catheter complications and encounters get their own ICD-10 codes, distinct from the placement procedure. Validated live against the FY2026 ICD-10-CM code set:
| Code | Description |
|---|---|
Z49.02 | Encounter for fitting and adjustment of peritoneal dialysis catheter |
Z49.32 | Encounter for adequacy testing for peritoneal dialysis |
T85.611A | Breakdown (mechanical) of intraperitoneal dialysis catheter, initial encounter |
T85.621A | Displacement of intraperitoneal dialysis catheter, initial encounter |
T85.71XA | Infection and inflammatory reaction due to peritoneal dialysis catheter, initial encounter |
Each T85 complication code has its own subsequent-encounter (D) and sequela (S) variant — use the initial-encounter (A) code only for the visit where active treatment is happening, not every follow-up referencing the same issue. A note documenting "exit-site erythema and cloudy effluent, catheter removed and cultures sent" supports T85.71XA plus the organism-specific code once cultures confirm it; a note that just says "PD-related infection" pushes the coder toward a less specific T85 code than the chart may actually support.
Equipment and supplies: the Home Dialysis benefit, not standard DME
Home dialysis equipment — the cycler or hemodialysis machine, tubing, dialysate, and related consumables — is billed by the certified dialysis facility under the Medicare Home Dialysis Supplies and Equipment benefit, not by the physician and not through standard DME supplier channels the way a wheelchair or CPAP machine would route. Practices that treat a home dialysis equipment question as a routine DME billing question end up pointing the claim at the wrong payer path entirely.
Water treatment systems are the one piece of this benefit with a standing national coverage decision worth knowing by name. We confirmed the following live against CMS's national coverage database (NCD 230.7, "Water Purification and Softening Systems Used in Conjunction with Home Dialysis," benefit category Home Dialysis Supplies and Equipment, effective 05/01/1989):
- 1Water purification systems are covered. Either deionization or reverse osmosis (RO) satisfies Medicare's requirement that home dialysis water be free of hazardous trace metals and organic contaminants. Running both in series is called out as medically unnecessary, and spare deionization tanks aren't covered as a precautionary supply.
- 2Water softening systems are excluded by default — a standalone softener doesn't adequately remove heavy-metal contaminants like arsenic — unless it's pretreating water specifically for an RO unit whose manufacturer requires it, the patient's water is demonstrated to fall short, and the softener is used only for that purpose.
- 3Replacing an existing softener with a purification system needs documented medical necessity. The MAC can ask the physician for the reason — evolving standards, deteriorating water quality, prior inability to afford purification — and may require a water analysis before approving it.
- 4Activated carbon filters are covered when physician-prescribed, specifically to remove unsafe chlorine and chloramine concentrations as part of the purification system.
This is a narrow rule, but it's exactly the kind of claim that denies for lacking a clinical justification note: a softener ordered without documentation tying it to RO pretreatment, or a system upgrade billed without the physician's stated reason, is denying against a real, citable NCD — not an ambiguous internal payer policy.
Do and don't
- Write the visit note to match the modality actually in use — peritoneal catheter and exchange pattern for PD, vascular access for HHD.
- Close out 90989 the same period training actually completes, with a session log that reconciles to the 90993 claims that preceded it.
- Route equipment and water-treatment claims through the Home Dialysis Supplies and Equipment benefit, with a documented clinical reason for any water softener tied to RO pretreatment.
- Confirm your specific MAC's current telehealth modifier policy for 90966 before submitting a claim built around a remote monthly visit.
- Don't assume PD and HHD training share one session cap — track them separately against their own limits.
- Don't bill a standalone water softener as routine home dialysis equipment without documenting the RO-pretreatment justification.
- Don't route home dialysis equipment claims through standard DME supplier channels.
- Don't carry a telehealth modifier convention for 90966 from one MAC's guidance into another's territory.
Not sure your home dialysis claims are capturing every training and equipment dollar?
We'll review a sample of your PD and home hemodialysis claims for training-cap, MCP documentation, and equipment-benefit routing errors, and show you what's recoverable.
Frequently asked questions
Do peritoneal dialysis and home hemodialysis use different MCP codes?
No. The age-banded home dialysis MCP codes (90963-90966 for a full month, 90967-90970 for a partial month) apply the same way regardless of modality — code selection turns on the patient's age band and whether the month is complete, not on whether the patient is on peritoneal dialysis or home hemodialysis. What has to change between the two is the clinical content of the visit note: a PD chart should reference the peritoneal catheter, exit-site status, and dialysate exchange pattern, while an HHD chart should reference the vascular access. A note written for the wrong modality is a documentation red flag even when the code itself is correct.
What's the difference between CPT 90989 and 90993 for home dialysis training?
90989 reports a completed course of dialysis training, billed once the patient (and helper, where applicable) has finished and is ready for independent home dialysis. 90993 reports training per session for a course not yet completed, billed once for each qualifying session. Billing 90989 before training has actually concluded, or billing 90993 indefinitely without ever closing the course out, both create a documentation mismatch against the training log that a payer can catch on review.
Is a telehealth modifier required on 90966 when the physician's monthly visit is delivered remotely?
There's no single national answer. Whether a 95 or GT modifier is required, permitted, or simply not applicable to 90966 depends on the specific Medicare Administrative Contractor and the specific payer's telehealth billing policy, and it changes as telehealth rules are updated. Confirm current requirements directly with your MAC's provider contact center or the payer's own telehealth billing guidance before submitting — don't carry a modifier convention from one region into another.
Verify before billing. CPT is a registered trademark of the American Medical Association; codes here are paraphrased, not reproduced from the CPT Professional edition. CPT, HCPCS and ICD-10 codes, coverage policy, and bundling edits change, including annual code-set updates. This page reflects standard industry practice and is provided for general education — it is not a substitute for your own compliance review, your current payer contracts, or the current-year code sets. Confirm requirements against your specific payer mix before submitting claims.