US · guidance
CMS Pub. 100-02, ch. 15, § 310.3
Limitations for Coverage
Medicare Part B covers KDE services:
• Up to six (6) sessions as a beneficiary lifetime maximum. A session is 1 hour. In
order to bill for a session, a session must be at least 31 minutes in duration. A
session that lasts at least 31 minutes, but less than 1 hour still constitutes 1
session.
• On an individual basis or in group settings; if the services are provided in a group
setting, a group consists of 2 to 20 individuals who need not all be Medicare
beneficiaries.
NOTE: Two HCPCS codes were created for this benefit and one or the other must be
present, along with the appropriate ICD diagnosis codes.
The diagnosis codes are:
• ICD-9-CM - code 585.4 (chronic kidney disease, Stage IV (severe)), or
• ICD-10-CM - code N18.4 (chronic kidney disease, Stage IV).
The HCPCS codes are:
• G0420: Face-to-face educational services related to the care of chronic kidney
disease; individual, per session, per one hour
• G0421: Face-to-face educational services related to the care of chronic kidney
disease; group, per session, per one hour
History
(Rev. 194, Issued: 09-03-14, Effective: Upon Implementation of ICD-10, Implementation: Upon Implementation of ICD-10)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
349d244858958a7b6ae3ede00ed3b9ffeec00578317f2fa8218f528f888d6f05
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