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INSTRUCTIONS FOR COMPLETING ESRD FACILITY INCIDENT REPORT FORMHEALTH AND HUMAN SERVICES COMMISSIONFACILITY LICENSING GROUPUse this form to notify HHSC of an incident and the actions taken by the facility.

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The codes to report end-stage renal disease services are in the range 90951-90970. For patients with ESRD, dialysis services are reported on a monthly basis, with a code from the 90951-90966. Codes 90967-90970 are billed per day for services lasting less than a full month.

End-Stage Renal Disease Services CPT® Code range 90951- 90970.

End-Stage Renal Disease Services CPT® Code range 90951- 90970.

CPT ® 90961 - End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 2-3 face-to-face visits by a physician or other qualified health care professional per month.

The Current Procedural Terminology (CPT®) code 90966 as maintained by American Medical Association, is a medical procedural code under the range - End-Stage Renal Disease Services.

The physician or other practitioner can bill only one of three current procedural terminology (CPT) codes for ESRD-related visits of one per month, two to three per month, or four or more per month (CMS, Medicare Claims Processing Manual, Pub. No. 100-04, chapter 8, § 140.1).

Procedure codes 90967-90970 are for home dialysis ESRD members who are hospitalized during the month. These procedure codes can be used to report daily management for the days the member is not in the hospital.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232