Acute kidney injury

Since January 1, 2017, Medicare has covered and made payments to both hospital-based and freestanding end-stage renal disease (ESRD) facilities for renal dialysis services furnished to beneficiaries with acute kidney injury (AKI). 

There are no billing limits for treatments during a monthly billing cycle; however, there will only be payment for one treatment per day. 

ESRD facilities must provide all items and services necessary to treat their patients with AKI. 

Items and services NOT considered renal dialysis services, but related to AKI, are paid separately. 

Do not report modifier AY or procedure code 90999 (dialysis procedure code) on claims with AKI services.

The ESRD network fee reduction does not apply to AKI claims. 

Effective January 1, 2025, we allow ESRD facilities to perform AKI home dialysis and AKI home dialysis training and bill for back-up in-facility AKI dialysis. As of July 1, 2026, we require ESRD facilities to bill an additional condition code alongside condition code 84 for the following situations:

• Use condition code 74 when billing AKI claims for dialysis in the home setting
• Use either condition code 73 or 87, as appropriate, when billing AKI claims for training or re-training for AKI home dialysis and self-dialysis
• Use condition code 76 when billing for back-up in-facility dialysis for AKI patients

Billing requirements

References 

• Acute Kidney Injury and ESRD Facilities
• MM14354 Acute Kidney Injury & ESRD Billing: Ending the AX Modifier Requirement
• Change Request 10839 System Changes to Implement Epoetin Alfa Biosimilar, Retacrit for End Stage Renal Disease (ESRD) and Acute Kidney Injury (AKI) Claims
• MM14159 Acute Kidney Injury Renal Dialysis Billing: Additional Revenue Codes