CurrentUnitedHealthcarePolicy BIP044.O

Dialysis services (acute and chronic hemodialysis and peritoneal dialysis)

Defines coverage and limitations for acute and chronic dialysis services and supplies (peritoneal and hemodialysis) for UnitedHealthcare West members, including authorization and network requirements.

Policy Summary

PayerUnitedHealthcare

PolicyDialysis services (acute and chronic hemodialysis and peritoneal dialysis)

Policy CodePolicy BIP044.O

Change TypeRoutine review — no material change

Effective DateJan 1, 2026

Next Review Date

Key ActionObtain authorization from the member's network medical group or UnitedHealthcare before providing acute or chronic dialysis.

SourceLink

POLICY UPDATE CHANGES

Routine review; no change to coverage guidelines.

acute & chronictypes of dialysis covered

home hemodialysisseparate policy required

not coveredtravel/out-of-area

requiredauthorization

Coverage Criteria for Dialysis Services

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Covered Benefits — Acute and Chronic Dialysis

Covered when ALL of the following are met

Covered dialysis services: Acute and chronic dialysis (peritoneal or hemodialysis) services and supplies are covered.

Benefits limited to equipment/supplies meeting member needs and plan specifications.

Authorization and network: Dialysis must be authorized by the member's network medical group or UnitedHealthcare and provided within the member's network medical group.

Being outside the geographic area does not entitle the member to coverage for maintenance of chronic dialysis to facilitate travel.

Medical necessity and plan terms: All services must be medically necessary and coverage is subject to the member's Evidence of Coverage/Schedule of Benefits; if there is a discrepancy between this policy and the member's EOC/SOB, the EOC/SOB will govern.

The following services are not covered: travel dialysis and non-emergent out-of-area dialysis services. These items are excluded from benefits and will be denied when billed as maintenance or elective dialysis provided to facilitate travel or when received outside the member’s network for non-emergent reasons.

Provider Requirements and Authorization

Prior Authorization

Prior Authorization Required

Acute and chronic dialysis (peritoneal or hemodialysis) services and supplies require authorization. Authorization must be obtained from the member's network medical group or UnitedHealthcare. Dialysis must be provided within the member's network medical group when required by the plan. Members outside the geographic area served by the network medical group are not entitled to coverage for maintenance chronic dialysis solely to facilitate travel.

Applies to acute and chronic dialysis (peritoneal and hemodialysis)
Authorization source: member's network medical group or UnitedHealthcare

Prior Authorization

Home Hemodialysis Prior Criteria

For home hemodialysis, coverage is subject to the criteria specified in the separate Medical Policy titled "Home Hemodialysis." Providers must follow the prior criteria and documentation requirements in that policy before coverage will be authorized.

See Medical Policy: Home Hemodialysis for required criteria prior to coverage
Benefits limited to equipment/supplies that meet minimum specifications

Documentation Required

Medical Necessity and Authorization

All services must be medically necessary and are subject to the member's Evidence of Coverage/Schedule of Benefits. When there is a discrepancy between this policy and the member's EOC/SOB, the EOC/SOB governs. Acute and chronic services require authorization as applicable.

Medical necessity required for all services
Follow member's EOC/SOB for plan-specific provisions

Denial Risk

Network/Location-based Denial Risk

Maintenance chronic dialysis provided outside the member's network medical group or non-emergent out-of-area dialysis (including travel dialysis) is not covered and may be denied.

Travel dialysis and non-emergent out-of-area dialysis services are not covered
Providing maintenance chronic dialysis outside the network medical group risks noncoverage/denial

Background

Dialysis provides renal replacement therapy for both acute and chronic kidney failure and includes two primary modalities: hemodialysis and peritoneal dialysis. Coverage in this policy applies to both acute and chronic dialysis services and related supplies when medical necessity, authorization, and network requirements are met. Home hemodialysis is a distinct modality with its own required criteria and prior authorization rules; refer to the separate Home Hemodialysis medical policy for coverage requirements specific to home hemodialysis.

Definitions

Home Hemodialysis — Definition and related policy

DefinitionHome hemodialysis: hemodialysis delivered in the member's home setting which requires meeting specific criteria detailed in the separate Home Hemodialysis medical policy.

Prior criteriaCoverage requires meeting the criteria specified in the separate Home Hemodialysis medical policy; providers must refer to that policy for required conditions prior to coverage.

Medicare enrollment noteFor chronic hemodialysis, application for Medicare Part A and Part B coverage must be made when applicable.

Benefits limitationBenefits for home hemodialysis are limited to equipment or supplies that meet the minimum specifications for the needs of the member.

Related policySee the separate medical policy titled 'Home Hemodialysis' for full criteria and requirements.