Summary & Overview
HCPCS G1026: Adult Hemodialysis Catheter Patient-Months
HCPCS Level II code G1026 quantifies adult patient-months for patients receiving maintenance hemodialysis via a catheter continuously for three months or longer under the care of the same practitioner or group partner at the end of the reporting month. The measure captures a specific quality and utilization denominator used in dialysis reporting and quality programs, informing tracking of prolonged catheter dependence among adult hemodialysis patients. Nationally, this code matters for facility-level quality monitoring, payer reporting, and programmatic oversight of vascular access management.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmark and coverage context for how G1026 is used across major commercial payers and Medicare, an explanation of the clinical context of prolonged catheter use in maintenance hemodialysis, and the typical sites and service type associated with the code. The publication outlines intended uses of the metric in quality programs, reporting considerations, and where to find related codes or reporting elements.
Data not available in the input: specific payer policies, reimbursement rates, associated taxonomies, and ICD-10 diagnosis mappings are not provided.
Billing Code Overview
HCPCS Level II code G1026 records the number of adult patient-months in the denominator who were on maintenance hemodialysis using a catheter continuously for three months or longer under the care of the same practitioner or group partner as of the last hemodialysis session of the reporting month.
Service type: Quality measure reporting for maintenance hemodialysis catheter use
Typical site of service: Outpatient hemodialysis facilities and dialysis centers
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with end-stage renal disease (ESRD) receiving maintenance hemodialysis through a tunneled central venous catheter has been treated by the same nephrology group for over a year. The practice tracks monthly quality and performance measures and reports the number of adult patient-months who have been on maintenance hemodialysis using a catheter continuously for three months or longer and who were under the care of the same practitioner or group partner as of the last hemodialysis session of the reporting month. Clinical workflow: the dialysis unit documents vascular access type at each session, the nephrology clinic maintains continuity of care records, coding staff aggregate patient-months meeting the ≥3-month continuous catheter criterion, and the measure is submitted for quality reporting and internal performance monitoring. Typical site of service is an outpatient dialysis facility (inclusive of hospital-based outpatient dialysis units) with data capture from the dialysis treatment record and clinic continuity documentation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when substantially greater work is required for a procedure or service related to dialysis care documentation or access management beyond typical reporting tasks. |
23 |