Summary & Overview
HCPCS G9264: Maintenance Hemodialysis with Catheter-Dependent Access
HCPCS Level II code G9264 documents maintenance hemodialysis for patients who have been on dialysis for 90 days or more and continue to use a catheter for documented medical or patient reasons. This code captures clinical scenarios where arteriovenous fistula (AVF) or arteriovenous graft (AVG) placement is not performed or is declined, and establishes a billing descriptor tied to prolonged catheter-dependent dialysis care. Nationally, accurate use of G9264 matters for tracking vascular access patterns, patient safety initiatives, and program-level quality metrics in dialysis care.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical context, typical site of service, and the practical implications for facility billing and documentation. The publication outlines benchmarks and policy-relevant considerations affecting catheter-dependent dialysis populations, highlights common billing modifiers observed with similar services, and explains where data is available or missing. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code G9264 documents a patient receiving maintenance hemodialysis for greater than or equal to 90 days while using a catheter for documented clinical or personal reasons (for example, other medical reasons, patient declined arteriovenous fistula (AVF)/arteriovenous graft (AVG), or other patient reasons).
Service Type: Maintenance hemodialysis with catheter-dependent vascular access
Typical Site of Service: Outpatient dialysis center or hospital outpatient dialysis unit
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with end-stage renal disease (ESRD) has been receiving maintenance hemodialysis via a tunneled central venous dialysis catheter for more than 90 days. The patient has documented medical contraindications to arteriovenous fistula (AVF) or arteriovenous graft (AVG) creation (for example, severe peripheral vascular disease, limited life expectancy, or unsuitable vasculature) and/or has declined AVF/AVG after counseling. The dialysis unit documents ongoing catheter use on each monthly visit and the treating nephrologist documents the rationale for continued catheter dependence in the chart. Typical workflow includes monthly vascular access assessment, documentation of catheter function and complications, communication with vascular surgery regarding feasibility of AVF/AVG, and maintenance dialysis sessions in an outpatient hemodialysis center or hospital-based dialysis unit. Billing for code G9264 is supported by explicit documentation that the patient has been on maintenance hemodialysis ≥90 days and that catheter use is for documented reasons (medical, patient-declined, or other specified patient reasons).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required to manage access-related complications or extensive documentation exceeds typical service for dialysis access management. |