Claims Processing Error Affecting Select Home Dialysis Codes Resolved

April 25, 2022

The Department of Health Care Services (DHCS) announced on March 18, 2022, in an article titled “Monthly Block-Billing and By Report Billing Required for Home Dialysis Codes” that claims for the following HCPCS codes may have erroneously denied:

  • S9335 (home therapy, hemodialysis; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment [drugs and nursing services coded separately], per diem) and

  • S9339 (home therapy; peritoneal dialysis, administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment [drugs and nursing visits coded separately], per diem).

The system issue has now been resolved and claims should no longer erroneously deny however Medi-Cal will continue to monitor claim submissions.

As a reminder, HCPCS codes S9335 and S9339 require both monthly block-billing and “By Report” billing. Instructions on how to properly complete a claim for monthly block-billing, or “from-through” billing, as well as how to properly submit “By Report” documentation, may be found in the UB-04 Special Billing Instructions for Outpatients section of the Part 2 provider manual.