Summary & Overview
HCPCS G0491: Dialysis for Acute Kidney Injury at Medicare-Certified ESRD Facility
HCPCS Level II code G0491 identifies a dialysis procedure performed at a Medicare-certified End-Stage Renal Disease (ESRD) facility for patients with acute kidney injury (AKI) who do not have chronic ESRD. This code matters nationally because it designates services delivered in specialized dialysis centers to a population distinct from chronic dialysis patients, affecting coverage rules, facility workflows, and payer policies across public and commercial payers. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn the clinical and billing context of G0491, including how the service differs from chronic ESRD dialysis, the typical site of service, and the national payers relevant to coverage. The publication summarizes benchmark considerations, common payer practices, and recent policy or coding clarifications affecting in-center dialysis for AKI without ESRD. It also provides practical reference points for coding teams and revenue cycle staff to align documentation and billing with payer expectations. Data not available in the input is clearly indicated where applicable.
Billing Code Overview
HCPCS Level II code G0491 describes a dialysis procedure provided at a Medicare-certified End-Stage Renal Disease (ESRD) facility for patients with acute kidney injury who do not have ESRD. The service type is in-center dialysis procedure for acute kidney injury, and the typical site of service is a Medicare-certified ESRD dialysis facility (in-center dialysis unit).
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with acute tubular necrosis from sepsis is admitted to the hospital and develops rapidly worsening azotemia with hyperkalemia and volume overload refractory to medical management. He is hemodynamically stabilized and transferred to a Medicare-certified ESRD facility that accepts acute dialysis patients for short-term renal replacement therapy. In the facility, a team including a nephrologist, dialysis nurse, and vascular access specialist performs intermittent hemodialysis sessions using a temporary central venous dialysis catheter. The billing for each dialysis procedure is reported to Medicare using G0491 for acute kidney injury without end-stage renal disease. Clinical workflow includes pre-dialysis assessment (vitals, weight, labs), dialysis treatment delivery and monitoring, and post-dialysis documentation of ultrafiltration, hemodynamic response, and follow-up plan. Treatment frequency and duration are determined by the nephrologist based on ongoing urine output, electrolyte trends, and volume status.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Default; billed when no modifier applies |
23 |