`S9339` Hit periton dialysis diem

Home therapy; peritoneal dialysis, administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

Medicare coverage: Not payable by Medicare
Status: active (October 2026 file)

Medicare pricing for S9339

Physician Fee Schedule (CY 2026, RVU26D)

Status I: not valid for Medicare (Medicare uses another code).

Payer policies and prior authorization for S9339

4 of 4 payer prior-auth lists that name S9339 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas, Oxford Health Plans, UnitedHealthcare, UnitedHealthcare Community Plan.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Blue Cross and Blue Shield of Texas	Texas PA exemption (gold card), outpatient, fully insured	TX	prior auth required	Gold-card exemption available	Jul 1, 2026	BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range)
Oxford Health Plans	Oxford Health Plans	All	prior auth under conditions	site of care: home, outpatient	Oct 1, 2026	Prior Authorization Requirements for Oxford Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare Mid-Atlantic Health Plans	All	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Mid-Atlantic Health Plans Effective October 1, 2026
UnitedHealthcare Community Plan	Massachusetts Senior Care Options (SCO) and OneCare	MA	prior auth required		Oct 1, 2026	Prior authorization requirements for Massachusetts MA SCO OneCare Effective October 1, 2026

Payer coverage policies that name S9339

S9339 appears in 4 coverage policies from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Dialysis (0541)	covered if criteria are met	Aug 26, 2026	payer document
Aetna	Home Health Aides (0218)	listed, no stance (range S9325-S9379)	Sep 10, 2026	payer document
Aetna	Kidney Transplantation (0493)	listed, no stance	Jul 30, 2026	payer document
Aetna	Pancreas Kidney Transplantation (0587)	listed, no stance	Sep 8, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

MA: $35.58 (dme_rates), effective Mar 1, 2026
ND: $63.13 (physician), effective Aug 1, 2026
VA: $37.60 (dme), effective Dec 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

S9339 Hit periton dialysis diem