CommercialBilling CodesHigh impact
23-482 Bill Correctly to Get Paid for Dialysis Treatments
Health Net·CA · Nephrology·Reimbursement
Effective date
Aug 10, 2023
We identified it
Jun 20, 2026
Summary
Health Net now requires specific G1-G6 modifiers when billing CPT code 90999 for hemodialysis treatments, based on the patient's Urea Reduction Ratio (URR) percentage. Claims for dialysis services will be denied without the appropriate modifier indicating treatment adequacy.
Action Required
By August 10, 2023: Dialysis billing staff must update billing procedures to include required G1-G6 modifiers when billing CPT 90999 based on patient URR percentages (G1 for <60%, G2 for 60-64.9%, G3 for 65-69.9%, G4 for 70-74.9%, G5 for 75%+, G6 for <7 sessions/month). Update billing software to require modifier selection for CPT 90999 on bill types 72X with revenue code 082X. Claims will be denied without proper modifiers.