Summary & Overview
CPT 90935: Hemodialysis Procedure with Single Physician Evaluation
CPT code 90935 is a nationally recognized billing code for hemodialysis procedures involving a single physician evaluation. This code is essential for documenting and reimbursing acute hemodialysis services provided in hospital inpatient or outpatient dialysis settings. The code is widely used by nephrology and internal medicine physicians, as well as nurse practitioners, to capture the clinical work associated with managing patients undergoing hemodialysis.
Major payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication provides a comprehensive overview of payer coverage, policy updates, and clinical benchmarks relevant to CPT code 90935. Readers will gain insight into the clinical context of hemodialysis procedures, typical sites of service, and the importance of accurate coding for physician evaluations during dialysis sessions. The summary also highlights common modifiers and associated taxonomies, offering a clear understanding of how this code fits into broader dialysis care and billing practices.
This article is designed to inform healthcare professionals, billing specialists, and policy analysts about the national landscape for CPT code 90935, including payer coverage and clinical application. It serves as a resource for understanding the role of this code in acute hemodialysis care and its significance in medical billing and policy.
CPT Code Overview
CPT code 90935 represents a hemodialysis procedure with a single physician evaluation. This service is categorized under Dialysis Services – Hemodialysis Procedures and is typically performed in a hospital inpatient or outpatient dialysis setting, specifically for acute hemodialysis. The code is used to document and bill for the physician's evaluation during a single hemodialysis session, ensuring accurate tracking of clinical care provided in these settings.
Clinical & Coding Specifications
Clinical Context
A patient with chronic kidney disease, such as end stage renal disease, presents to a hospital outpatient dialysis unit for scheduled hemodialysis. The nephrology physician evaluates the patient before the procedure, reviews laboratory results, assesses fluid status, and determines the dialysis prescription. The patient undergoes a single hemodialysis session, and the physician documents a single evaluation during the treatment. This workflow is typical for acute hemodialysis in hospital settings, where the physician's involvement is limited to one evaluation per session, as described by CPT code 90935.
Coding Specifications
-
Modifier
26: Indicates the professional component of the service, used when only the physician's evaluation is billed (not the facility or technical component). -
Modifier
52: Used when the service provided is reduced from the usual protocol, such as a shortened dialysis session or partial evaluation.
| Provider Taxonomy Code | Specialty Name |
|---|---|
207RN0300X |