Hemodialysis for Schizophrenia

Number: 0291

Policy

Aetna considers hemodialysis for the treatment of schizophrenia experimental and investigational because the effectiveness of this treatment has not been demonstrated.

Background

A number of investigators presented reports of series of schizophrenic patients whose symptoms were reportedly improved with hemodialysis (American Psychiatric Association, 1979; Malek-Ahmdi et al, 1980).  Subsequent, well-designed, sham-controlled clinical trials, however, have found that hemodialysis had no significant effect on schizophrenia symptoms (Vanherweghern et al, 1979; Diaz-Buxo et al, 1980; Schulz and Van Kammen, 1981; Carpenter et al, 1983; Schulman et al, 1983; Vanherweghern et al, 1983; van Kammen et al, 1983; Wagemaker et al, 1983; Wagemaker et al, 1984; Schulman, 1985).

A Medicare National Coverage Determination states: "Scientific evidence supporting use of hemodialysis as a safe and effective means of treatment for schizophrenia is inconclusive at this time. Accordingly, Medicare does not cover hemodialysis for treatment of schizophrenia."


Table: CPT Codes / HCPCS Codes / ICD-10 Codes
Code Code Description

Information in the [brackets] below has been added for clarification purposes.   Codes requiring a 7th character are represented by "+":

CPT codes not covered for indications listed in the CPB:

90935 Hemodialysis procedure with single physician evaluation
90937 Hemodialysis procedure requiring repeated evaluation(s) with or without substantial revision of dialysis prescription

ICD-10 codes not covered for indications listed in the CPB:

F20.0 - F20.9 Schizophrenia
Z49.01 - Z49.32 Encounter for care involving renal dialysis
Z99.2 Dependence on renal dialysis

The above policy is based on the following references:

  1. Balow JE, Schulz SC, van Kammen DP, Bunney WE Jr. Controlled trial of hemodialysis in schizophrenia. Proceed Clin Dialysis Transplant Forum. 1980:10:203-206.
  2. Carpenter WT Jr, Sadler JH, Light PD, et al. Schizophrenia and dialysis. Artificial Organs. 1983;7(3):357-364.
  3. Carpenter WT Jr, Sadler JH, Light PD, et al. The therapeutic efficacy of hemodialysis in schizophrenia. N Engl J Med. 1983;308(12):669-675.
  4. Centers for Medicare & Medicaid Services (CMS). National coverage determination (NCD) for hemodialysis for treatment of schizophrenia (130.8). Baltimore, MD: CMS. undated.
  5. Diaz-Buxo JA, Caudle JA, Chandler JT, et al. Dialysis of schizophrenic patients: A double-blind study. Am J Psychiatry. 1980;137(10);1220-1222.
  6. Linkowski P, Vanherweghem JL, Jadot C, Mendlewicz J. Haemodialysis in schizophrenia. Lancet. 1979;2(8156-8157):1381-1382..
  7. Malek-Ahmadi P, Davis D, Sorkin MI, Callen KE. Effect of hemodialysis on hallucinations. Southern Med J. 1980;73(4):520-521.
  8. No authors listed. Schizophrenia and dialysis: Treatment or placebo. Conference Proceeding. 132nd Annual Meeting of the American Psychiatric Association. Chicago, IL, May 12-18, 1979. Arlington, VA: American Psychiatric Association; 1979.
  9. Schulman A. Hemodialysis in the treatment of a group of schizophrenic patients. Acta Psychiatr Scand Suppl. 1985;321:1-127.
  10. Schulz SC, Van Kammen DP. Dialysis in schizophrenia: A double-blind evaluation. Science. 1981;211(4486):1066-1068.
  11. Splendiani G, Giammaria U, Daniele M, Tancredi M. Dialysis in nonuremia. Contrib Nephrol. 1989;70:277-283.
  12. van Kammen DP, Schulz SC, Balow JE, et al. Failure of hemodialysis to diminish psychotic behavior in schizophrenia: Behavioral and psychophysiological evaluation. Artificial Organs. 1983;7(3):310-316.
  13. Vanherweghem JL, Linkowski P, Jadot C, Mendlewicz J. Haemodialysis in schizophrenia: A double blind study - preliminary report. Proceed Europ Dialysis Transplant Assoc. 1979;16:148-154.
  14. Vanherweghem JL, Linkowski P, Mendlewicz J. Hemodialysis in schizophrenics. A double-blind study. Arch Gen Psychiatry. 1983;40(2):211-214.
  15. Wagemaker H, Rogers JL, Cade R. Effectiveness of hemodialysis in chronic schizophrenic patients: A double-blind study. Artificial Organs. 1983;7(3):295-303.
  16. Wagemaker H, Rogers JL, Cade R. Schizophrenia, hemodialysis, and the placebo effect. Results and issues. Arch Gen Psychiatry. 1984;41(8):805-810.