Summary & Overview
CPT 90937: Hemodialysis with Repeated Evaluations
Headline: Repeated-Evaluation Hemodialysis Code CPT 90937 Clarified for National Use
Lead: CPT 90937 represents hemodialysis procedures that include repeated physician evaluations during the dialysis session, with or without substantial revision of the dialysis prescription. The code is central to billing for complex dialysis encounters where ongoing clinical reassessment alters treatment.
What the code represents and why it matters: CPT 90937 is used for hemodialysis encounters requiring repeated assessments and potential prescription changes during the same dialysis session. It distinguishes higher-intensity clinical involvement from single-evaluation dialysis services and affects clinical documentation and billing across outpatient dialysis settings nationally.
Key payers covered: Coverage considerations analyzed include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare.
Overview of reader takeaways: Readers will find a concise explanation of the clinical and billing context for CPT 90937, how it differs from single-evaluation dialysis codes, and the typical settings where it is reported. The publication outlines common accompanying diagnoses that justify repeated evaluations, highlights related CPT comparisons for coding clarity, and identifies documentation components tied to this service. Where input fields lacked information, the publication notes "Data not available in the input." This piece is intended to inform coding, compliance, and policy review rather than provide clinical recommendations.
CPT Code Overview
CPT 90937 describes a hemodialysis procedure requiring repeated evaluation(s) with or without substantial revision of dialysis prescription. This code applies to hemodialysis sessions in which the treating clinician performs multiple evaluations of the patient during the course of the dialysis service and may substantially revise the dialysis prescription based on those assessments.
Service Type: Hemodialysis Procedures
Typical Site of Service: End-Stage Renal Disease (ESRD) facility (Place of Service 65) or physician’s office (Place of Service 11)
Clinical & Coding Specifications
A 62-year-old patient with established end-stage renal disease attends a scheduled session at an ESRD facility (Place of Service 65) for maintenance hemodialysis. During the treatment the nephrology physician performs repeated evaluations of the dialysis prescription because the patient develops intradialytic hypotension and signs of inadequate ultrafiltration. The physician evaluates vascular access function, reviews recent laboratory values, adjusts dialysate composition and ultrafiltration rate, and documents substantial revisions to the dialysis prescription before continuing therapy. The facility staff carry out the dialysis procedure while the physician supervises and documents the repeated evaluations and prescription changes. This procedure may also occur in a physician’s office (Place of Service 11) for select patients requiring intensive prescription management.
Modifiers
25— Significant, separately identifiable evaluation and management service by the same physician on the same day as the procedure; used when reporting an E/M service in addition to dialysis codes when the E/M is distinct from the dialysis-related work.
Associated provider taxonomies
| Taxonomy Code | Specialty |
|---|---|
207RN0300X | Nephrology Physician |
207R00000X | Internal Medicine Physician |
261QM1300X | Multi-Specialty Group |
- Nephrology Physician (
207RN0300X): Specialty focused on kidney disease and dialysis management. - Internal Medicine Physician (
207R00000X): General internal medicine providers who may manage dialysis patients and chronic conditions related to kidney disease. - Multi-Specialty Group (
261QM1300X): Group taxonomy representing clinics with multiple specialties that may provide or coordinate dialysis care.
-
N18.6— End stage renal diseaseClinical relevance: End-stage renal disease indicates permanent kidney failure requiring chronic dialysis; it is a primary indication for hemodialysis procedures such as
90937. -
N18.5— Chronic kidney disease, stage 5Clinical relevance: Stage 5 CKD denotes severe loss of kidney function often managed with dialysis; supports medical necessity for hemodialysis and prescription adjustments.
-
I12.0— Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal diseaseClinical relevance: Hypertensive CKD with stage 5 or ESRD reflects comorbid hypertension contributing to kidney failure; relevant to dialysis management and potential medication or prescription changes during hemodialysis.
-
Z99.2— Dependence on renal dialysisClinical relevance: Indicates patient dependence on dialysis therapy; documents the ongoing need for regular hemodialysis sessions billed with codes such as
90937when repeated evaluations occur. -
N18.4— Chronic kidney disease, stage 4 (severe)Clinical relevance: Stage 4 CKD is severe renal impairment that may progress to dialysis; may be present in patients transitioning to or requiring closer dialysis prescription monitoring and evaluation.
| CPT Code | Description |
|---|---|
90935 | Hemodialysis procedure with single evaluation by a physician or other qualified health care professional |
90945 | Dialysis procedure other than hemodialysis with single evaluation |
90947 | Dialysis procedure other than hemodialysis requiring repeated evaluations |
-
90935: Represents hemodialysis with a single physician evaluation during the session; used when only one evaluation is required rather than repeated evaluations. -
90945: Represents non-hemodialysis dialysis procedures (e.g., peritoneal dialysis or other modalities) with a single evaluation; an alternative when the modality is not hemodialysis. -
90947: Represents non-hemodialysis procedures that require repeated evaluations; analogous to90937for other dialysis modalities. -
Common usage:
90937is selected when repeated evaluations and/or substantial prescription revisions are performed during hemodialysis.90935is an alternative when only a single evaluation occurs.90945and90947are alternatives for dialysis modalities other than hemodialysis.
National Reimbursement Benchmarks
National commercial mean rates for 90937 are meaningfully higher than Medicare. The BUCA (aggregate commercial) mean of $141.86 is about 57% above the Medicare mean of $90.43, indicating a substantial commercial-to-Medicare gap in allowed amounts.
Rate dispersion varies by payer. UnitedHealth Group and Cigna show the widest interquartile spreads (UHC P75–P25 = $98.00; Cigna P75–P25 = $91.00), while Medicare is the tightest (P75–P25 = $4.00). Aetna and BUCA have moderate dispersion (Aetna = $33.83; BUCA = $66.00). The table and chart below present the full breakdown.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.