Hemodialysis for Schizophrenia
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This policy governs the use of hemodialysis as a treatment for schizophrenia and is intended for providers and payers determining coverage for this indication.
No material clinical or coverage changes in this revision.
Coverage Determination
Experimental / Investigational — Coverage statement
Covered when ALL of the following are met:
Based on lack of demonstrated efficacy in sham-controlled trials and systematic review evidence.
Use of hemodialysis specifically to treat schizophrenia is excluded from coverage as experimental and investigational. The policy states that "Hemodialysis for the treatment of schizophrenia is considered experimental and investigational because the effectiveness of this approach has not been demonstrated and established." In addition, the Medicare National Coverage Determination similarly finds the evidence inconclusive and does not cover hemodialysis for the treatment of schizophrenia.
Hemodialysis for schizophrenia is considered not medically necessary because randomized, sham-controlled trials and a systematic review found no consistent therapeutic benefit. Multiple well-designed sham-controlled trials failed to show a significant effect on schizophrenia symptoms, and a systematic review identified 9 randomized, double-blinded trials (total n = 105) with mostly negative results; adverse events were reported in 23% of patients. Given the lack of demonstrated efficacy and the occurrence of harms, hemodialysis is not supported as a treatment for schizophrenia.
Relevant Codes
| F20.0 - F20.9 | Schizophrenia |
| Z49.01 - Z49.32 | Encounter for care involving renal dialysis |
| Z99.2 | Dependence on renal dialysis |
Provider Billing & Documentation Guidance
Prior authorization consideration for dialysis codes (90935, 90937)
Hemodialysis procedure codes such as CPT 90935 and 90937 billed for the indication of schizophrenia are not supported by this policy because hemodialysis for schizophrenia is considered experimental and investigational and therefore is subject to prior authorization scrutiny and likely noncoverage.
Evidence does not support hemodialysis as effective therapy for schizophrenia
High-quality randomized, double-blinded trials with sham controls and a systematic review do not demonstrate consistent benefit for hemodialysis in schizophrenia; overall evidence does not support hemodialysis as an effective therapy for this indication.
- Multiple well-designed, sham-controlled clinical trials found no significant effect on schizophrenia symptoms (references summarized in chunk 6).
- Systematic review identified 9 trials (105 patients) with mostly negative results and reported adverse events in 23% of patients (chunk 7).
Documentation expectations if submitted — diagnosis codes and clinical rationale required
If a claim for hemodialysis for schizophrenia is submitted, include the specific schizophrenia diagnosis codes and a clear clinical rationale; despite submission of documentation, the policy states the treatment is experimental and investigational based on lack of demonstrated effectiveness.
- Include ICD-10 schizophrenia codes (F20.0–F20.9) on documentation and claims.
- Provide clinical rationale explaining indication; note that lack of demonstrated efficacy in sham-controlled trials is the basis for the policy determination.
Denial risk — hemodialysis for schizophrenia likely to be denied as experimental/investigational
Claims for hemodialysis billed for the treatment of schizophrenia are at risk for denial because the therapy is considered experimental and investigational and Medicare does not cover it.
- Policy: Hemodialysis for schizophrenia is considered experimental and investigational (chunk 3).
- Medicare NCD states evidence is inconclusive and does not cover hemodialysis for treatment of schizophrenia (chunk 6).
Clinical Background & Evidence Summary
Early uncontrolled reports from the late 1970s and early 1980s described symptom improvements in series of patients with schizophrenia after hemodialysis. However, these initial observations prompted randomized, double-blinded, sham-controlled trials that largely failed to replicate those findings. A systematic review (search through September 2018) identified 9 qualifying trials enrolling 105 patients; of those trials, one reported benefit, one reported harm, and six reported no effect. The review noted small study sizes, unclear or high risk of bias, and that adverse events occurred in 23% of patients. Overall, the later well-designed trials and the systematic review do not support hemodialysis as an effective treatment for schizophrenia.
Definitions & Code Descriptions
Policy Dates & History
Policy effective date (document header).
Most recent policy review date recorded in document header.
Next scheduled policy review date recorded in document header.
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