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Clinical Policy Bulletin:
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."
 
CPT Codes / HCPCS Codes / ICD-9 Codes
CPT codes not covered for indications listed in the CPB:
90935
90937
ICD-9 codes not covered for indications listed in the CPB:
295.00 - 295.95 Schizophrenic disorders
V56.0 - V56.8 Encounter for dialysis and dialysis catheter care


The above policy is based on the following references:
  1. Schulman A. Hemodialysis in the treatment of a group of schizophrenic patients. Acta Psychiatr Scand Suppl. 1985;321:1-127.
  2. Splendiani G, Giammaria U, Daniele M, Tancredi M. Dialysis in nonuremia. Contrib Nephrol. 1989;70:277-283.
  3. Wagemaker H, Rogers JL, Cade R. Schizophrenia, hemodialysis, and the placebo effect. Results and issues. Arch Gen Psychiatry. 1984;41(8):805-810.
  4. Wagemaker H, Rogers JL, Cade R. Effectiveness of hemodialysis in chronic schizophrenic patients: A double-blind study. Artificial Organs. 1983;7(3):295-303.
  5. 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.
  6. Vanherweghem JL, Linkowski P, Mendlewicz J. Hemodialysis in schizophrenics. A double-blind study. Arch Gen Psychiatry. 1983;40(2):211-214.
  7. Carpenter WT Jr, Sadler JH, Light PD, et al. Schizophrenia and dialysis. Artificial Organs. 1983;7(3):357-364.
  8. 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.
  9. Schulz SC, Van Kammen DP. Dialysis in schizophrenia: A double-blind evaluation. Science. 1981;211(4486):1066-1068.
  10. 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.
  11. 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.
  12. Malek-Ahmadi P, Davis D, Sorkin MI, Callen KE. Effect of hemodialysis on hallucinations. Southern Med J. 1980;73(4):520-521.
  13. Linkowski P, Vanherweghem JL, Jadot C, Mendlewicz J. Haemodialysis in schizophrenia. Lancet. 1979;2(8156-8157):1381-1382..
  14. 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.
  15. 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.
  16. Centers for Medicare & Medicaid Services (CMS). National coverage determination (NCD) for hemodialysis for treatment of schizophrenia (130.8). Baltimore, MD: CMS. undated. Available at: http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=68&ncdver=1&bc=AgAAQAAAAAAAAA%3D%3D&. Accessed February 6, 2014.


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Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.
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