Question 1

What is HCPCS code G1026?

Accepted Answer

HCPCS code G1026 is "Pt hemo > 3mo". The number of adult patient-months in the denominator who were on maintenance hemodialysis using a catheter continuously for three months or longer under the care of the same practitioner or group partner as of the last hemodialysis session of the reporting month

Question 2

What category is G1026 in?

Accepted Answer

G1026 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G1026?

Accepted Answer

Use G1026 when billing for pt hemo > 3mo. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is G1026 covered by Medicare?

Accepted Answer

Coverage for G1026 (Pt hemo > 3mo) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for G1026?

Accepted Answer

Documentation for G1026 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).