Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.31
    OpenPayerPolicy UpdatesDialysis/Renal ReplacementCigna Home Hemodialysis Coverage Update | OpenPaye…
    Ask Trek AI about this page
    CurrentCignaPolicy 0229

    Staff-Assisted Home Hemodialysis

    Customize your policy alerts

    Sign up for Cigna Policy 0229 alerts

    Get alerted when Policy 0229 changes without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    This policy governs coverage for the presence of professional staff during home hemodialysis treatments. Coverage varies by benefit plan and applies to providers requesting reimbursement for professional staff-assisted home hemodialysis.

    Policy Summary
    PayerCigna
    PolicyStaff-Assisted Home Hemodialysis
    Policy CodePolicy 0229
    Change TypeAnnual review revision
    Effective DateNov 15, 2026Today
    Next Review DateNov 15, 2027
    Key ActionConfirm that all six medical-necessity criteria are met and submit covered code 99512 for professional staff-assisted home hemodialysis.
    SourceLink
    POLICY UPDATE CHANGES

    The medically necessary and not medically necessary policy statements for professional staff-assisted home hemodialysis were revised during the 2026 annual review.

    6Required medical-necessity criteria
    99512Covered CPT code when criteria are met
    1Not-medically-necessary coverage condition
    5–7/weekTypical home hemodialysis frequency

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Coverage Criteria

    Medically Necessary Professional Staff-Assisted Home Hemodialysis

    Professional staff-assisted home hemodialysis (CPT® code 99512) is considered medically necessary when ALL of the following criteria are met:

    ALL of the following

    • The individual is stable on hemodialysis and is not at increased risk as a result of having the procedure performed outside of a dialysis facility.
    • The individual has a well-functioning vascular access.
    • The individual has a medical contraindication to leaving home for hemodialysis.
    • The individual and any available non-professional caregiver are incapable of performing home hemodialysis in the home setting.
    • The individual and/or non-professional caregiver has not successfully completed adequate home hemodialysis training, when such training has been provided.
    • Local hemodialysis facilities/centers have declined to accept the individual for in-facility hemodialysis.

    Not Medically Necessary

    The following services are considered not medically necessary:

    Professional staff-assisted home hemodialysis that does not meet all of the applicable medical-necessity criteria stated above.

    Professional staff-assisted home hemodialysis is not medically necessary when all of the applicable criteria stated above are not met.

    Covered Coding

    Considered Medically Necessary when applicable policy criteria are metCPTCovered
    99512Home visit for hemodialysis

    Provider and Billing Actions

    Denial Risk

    All six criteria must be met

    Confirm that all six medical-necessity criteria are satisfied before requesting reimbursement for professional staff-assisted home hemodialysis. If any criterion is not met, the service is considered not medically necessary and may be denied.

    • The individual is stable on hemodialysis and is not at increased risk from treatment outside a dialysis facility.
    • The individual has a well-functioning vascular access.
    • The individual has a medical contraindication to leaving home for hemodialysis.
    • The individual and any available non-professional caregiver are incapable of performing home hemodialysis at home.
    • The individual and/or non-professional caregiver has not successfully completed adequate home hemodialysis training, when training has been provided.
    • Local hemodialysis facilities or centers have declined to accept the individual for in-facility hemodialysis.
    Billing Rule

    Bill only covered diagnoses and codes

    Reimbursement may be denied when services are billed for conditions or diagnoses not covered under the policy or when the claim is not accompanied by a covered code. Use the most appropriate codes as of the submission date, including covered CPT code 99512 when the applicable criteria are met.

    • CPT 99512: Home visit for hemodialysis.
    • Claims without covered code(s) under the applicable Coverage Policy will be denied as not covered.

    Clinical Background

    Hemodialysis uses an artificial membrane to remove waste and excess fluid from the blood of individuals with kidney failure. Home hemodialysis may involve coordination among the nephrologist, dialysis nurse, technician, dietician, social worker, and other professionals, and generally requires participation by a trained patient or caregiver. Daily or nocturnal home hemodialysis is typically performed 5–7 times per week.

    ref``:

    Policy Summary
    PayerCigna
    PolicyStaff-Assisted Home Hemodialysis
    Policy CodePolicy 0229
    Change TypeAnnual review revision
    Effective DateNov 15, 2026Today
    Next Review DateNov 15, 2027
    Key ActionConfirm that all six medical-necessity criteria are met and submit covered code 99512 for professional staff-assisted home hemodialysis.
    SourceLink
    On This Page
    Coverage CriteriaCovered CodingProvider and Billing ActionsClinical Background