G9749 Palliative Dialysis (HCPCS) Reimbursement | OpenPayer

Summary & Overview

HCPCS G9749: Palliative Dialysis with Catheter

HCPCS Level II code G9749 designates encounters in which a patient receives palliative dialysis via catheter, reflecting dialysis delivered with comfort-focused goals rather than curative intent. This distinction matters nationally as the population of patients with advanced kidney disease and serious comorbidities grows, increasing demand for codes that capture goal-concordant, symptom-focused dialysis care.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain a concise understanding of the clinical context for G9749, typical sites of service, and the administrative use cases for identifying palliative dialysis encounters in claims data. The publication summarizes benchmark interpretations where available, notes policy and billing considerations affecting adoption and reporting, and outlines the coding context needed for payer communications and care planning.

This briefing is intended to inform billing managers, clinical coders, healthcare administrators, and policy analysts about the role of G9749 in documenting palliative dialysis with a catheter and the implications for claims classification and program-level reporting.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9749HCPCS Level IIpalliative dialysisdialysis catheterend-stage kidney diseasehospice carebilling and codingclinical documentationclaims reporting

Billing Code Overview

HCPCS Level II code G9749 denotes a situation where a patient is undergoing palliative dialysis with a catheter. This code represents a clinical encounter focused on providing dialysis with palliative intent rather than curative intent.

Service type: Palliative dialysis
Typical site of service: Hospital inpatient or outpatient dialysis unit, hospice setting, or other facility where dialysis via catheter is provided

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with end-stage renal disease (ESRD) receiving conservative, comfort-focused care who continues intermittent hemodialysis via a tunneled dialysis catheter for symptom control (palliative dialysis). The patient may be under hospice or palliative care services and dialyzed in an outpatient dialysis center, hospital dialysis unit, or at home with visiting nursing support. Clinical workflow: the nephrology team documents goals of care and palliative intent, verifies catheter patency and dressing, confirms dialysis prescription focused on symptom relief (shorter treatments, lower ultrafiltration goal), obtains consent aligned with palliative goals, coordinates with dialysis nursing for implementation, manages catheter-related issues (dressing change, heparin lock, antimicrobial protocols), and provides symptom-focused monitoring during and after treatment (pain, dyspnea, pruritus). Typical site of service: outpatient dialysis center, hospital inpatient or observation unit, hospice facility, or home dialysis with visiting RN support.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typical due to complexity of palliative access management or complications during catheter handling.
`23`

HCPCS G9090: Rectal Adenocarcinoma Disease Status, T1-2 N0 M0

HCPCS-G9238-OPTIMIZING-PATIENT-EXPOSURE-IONIZING-RADIATION

HCPCS G9238: Optimizing Patient Exposure to Ionizing Radiation Measures Group

HCPCS-G9561-OPIOID-THERAPY-OVER-SIX-WEEKS

HCPCS G9561: Patients Prescribed Opiates Longer Than Six Weeks

HCPCS-G0491-DIALYSIS-ACUTE-KIDNEY-INJURY-ESRD-FACILITY

HCPCS G0491: Dialysis for Acute Kidney Injury at Medicare-Certified ESRD Facility

HCPCS-G0010-HEPATITIS-B-VACCINE-ADMINISTRATION

HCPCS G0010: Administration of Hepatitis B Vaccine

HCPCS-G9149-NCQA-LEVEL-2-MEDICAL-HOME

HCPCS G9149: NCQA Level 2 Patient-Centered Medical Home

HCPCS-G8665-SHOULDER-FUNCTIONAL-STATUS-NOT-MEASURED-PATIENT-NOT-APPROPRIATE

HCPCS G8665: Shoulder Functional Status Not Measured, Patient Not Appropriate

HCPCS-G3002-CHRONIC-PAIN-MANAGEMENT-MONTHLY-BUNDLE

HCPCS G3002: Chronic Pain Management Monthly Bundle

HCPCS-G9755-DOCUMENTATION-NO-FOLLOW-UP-INTERVAL-OR-MODALITY

HCPCS G9755: Documentation of No Recommended Follow-Up Interval or Modality

HCPCS-G9536-ADVANCED-BRAIN-IMAGING-CLINICAL-INDICATIONS

HCPCS G9536: Documentation for Advanced Brain Imaging Indications

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`363A00000X`	Nephrology	Primary specialty managing dialysis prescriptions and palliative dialysis decisions.
`2080P0208X`	Palliative Medicine	Specialty focusing on symptom management and goals-of-care alignment for palliative dialysis.
`174400000X`	Dialysis Facility	Organizational taxonomy for outpatient dialysis centers providing treatments and catheter care.
`207K00000X`	Physician Assistant	Frequently provides procedural assistance and onsite management in dialysis settings.
`207L00000X`	Registered Nurse	Directly provides catheter care, dressing changes, and dialysis nursing support.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N18.6`	End stage renal disease	Primary indication for ongoing dialysis; common in patients receiving palliative dialysis.
`Z51.5`	Encounter for palliative care	Documents the palliative intent of dialysis treatments and guides care planning.
`T82.7XXA`	Infection and inflammatory reaction due to other vascular device, initial encounter	Relevant for catheter-related infections that may complicate palliative dialysis.
`Z48.02`	Encounter for removal of tunneled vascular catheter	Used when catheter removal is performed as part of care transitions or complications.
`I50.9`	Heart failure, unspecified	Common comorbidity affecting fluid management goals during palliative dialysis.
`R53.1`	Weakness	Symptom commonly managed by palliative dialysis to improve comfort and energy.
`R06.02`	Shortness of breath, orthopnea	Symptom management target for palliative dialysis when fluid overload causes dyspnea.
`A41.9`	Sepsis, unspecified organism	Possible serious complication of catheter-related infection requiring procedural decisions.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36818`	Insertion of tunneled centrally inserted central venous catheter, with subcutaneous port or pump, for dialysis	May be performed prior to or when converting dialysis access for palliative catheter-based dialysis.
`36556`	Exchange of tunneled central venous catheter for dialysis, over a guidewire	Used when a tunneled dialysis catheter requires exchange due to malfunction or infection while maintaining dialysis access.
`36561`	Insertion of non-tunneled central venous catheter; for dialysis	Performed for temporary dialysis access in acute palliative situations.
`99213`	Office or other outpatient visit for established patient, moderate complexity	Typical billing for nephrology or palliative follow-up visits managing palliative dialysis care.
`99024`	Postoperative follow-up visit global period, related to a dialysis catheter procedure	Used for routine post-procedural care related to catheter insertion or revision.
`A4928`	Needle, dialysis, any type, each (HCPCS level II example often used in dialysis supply billing)	Supplies and related CPT/HCPCS items commonly billed alongside dialysis sessions for palliative management.

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