Summary & Overview
CPT 90945: Dialysis Procedure Other Than Hemodialysis, Single Evaluation
CPT code 90945 represents dialysis procedures other than hemodialysis, including peritoneal dialysis, hemofiltration, and other continuous replacement therapies, with a single evaluation by a physician or qualified health care professional. This code is significant in the national landscape of renal care, as it addresses the billing and documentation needs for patients requiring alternative dialysis modalities.
Major payers such as Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare recognize and reimburse for services billed under CPT code 90945, ensuring broad coverage for patients with end stage renal disease or other forms of kidney failure.
Readers will gain insight into the clinical context of dialysis services, typical sites of service, and the importance of accurate coding for non-hemodialysis procedures. The publication provides benchmarks, policy updates, and a comprehensive overview of payer coverage, supporting stakeholders in understanding the evolving landscape of dialysis care and reimbursement. The summary also highlights related codes and modifiers, offering clarity on how CPT code 90945 fits within the broader framework of renal replacement therapy billing.
CPT Code Overview
CPT code 90945 is used to report dialysis procedures other than hemodialysis, such as peritoneal dialysis, hemofiltration, or other continuous replacement therapies. This code covers a single evaluation by a physician or other qualified health care professional during the dialysis session.
Dialysis Services and Procedures are typically performed in an End Stage Renal Disease (ESRD) facility (Place of Service 65) or a physician’s office (Place of Service 11). The code is essential for accurately documenting and billing for specialized dialysis care provided outside of standard hemodialysis.
Clinical & Coding Specifications
Clinical Context
A patient with end stage renal disease or acute kidney failure presents to an ESRD facility (Place of Service 65) or a physician’s office (Place of Service 11) for a dialysis procedure other than hemodialysis. The physician or other qualified health care professional performs a single evaluation and oversees the dialysis session, which may include peritoneal dialysis, hemofiltration, or other continuous replacement therapies. The clinical workflow involves assessment of the patient’s current status, review of laboratory results, adjustment of the dialysis prescription if needed, and monitoring for complications during the procedure. The service is typically provided by specialists in nephrology, internal medicine, or urology.
Coding Specifications
- Modifier
25: Used when a significant, separately identifiable evaluation and management service is performed by the same physician on the same day as the dialysis procedure.
| Modifier Code | Description |
|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day as the procedure |
- Associated Provider Taxonomies:
| Taxonomy Code | Specialty |
|---|---|
207RN0300X | Nephrology Physician |
207R00000X | Internal Medicine Physician |
208800000X | Urology Physician |
Related Diagnoses
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N18.6- End stage renal disease- Indicates patients with permanent loss of kidney function requiring dialysis, directly relevant to the procedure.
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N19- Unspecified kidney failure- Used when the type of kidney failure is not specified, but dialysis is required.
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N17.9- Acute kidney failure, unspecified- Applies to patients with sudden loss of kidney function needing urgent dialysis.
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N18.9- Chronic kidney disease, unspecified- Used for patients with chronic kidney disease where the stage is not specified, but dialysis may be indicated.
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Z99.2- Dependence on renal dialysis- Identifies patients who rely on dialysis for kidney function, supporting medical necessity for the procedure.
Related CPT Codes
90937- Dialysis procedure other than hemodialysis requiring repeated evaluations by a physician or other qualified health care professional, with or without substantial revision of dialysis prescription
Clinical Relationship:
90937is used when the dialysis procedure requires repeated evaluations or substantial revision of the dialysis prescription during the same session, whereas90945is for a single evaluation.- These codes are alternatives depending on the complexity and frequency of physician involvement during the dialysis session.
- They are not typically billed together for the same session.
National Reimbursement Benchmarks
Nationally, the mean rate for CPT code 90945 is highest among commercial payers, with UnitedHealth Group and Cigna both averaging above $138.00. Blue Cross Blue Shield and Aetna are lower, with mean rates of $114.40 and $108.37, respectively. The BUCA composite mean rate stands at $117.99. In contrast, Medicare's mean rate is significantly lower at $79.14.
Rate dispersion varies notably across payers. Medicare exhibits the tightest range, with a difference of only $5.00 between the 75th and 25th percentiles. Among commercial payers, Cigna and UnitedHealth Group show the widest spreads, with Cigna's range at $76.00 and UnitedHealth Group's at $83.00. Blue Cross Blue Shield and Aetna have more moderate dispersions, at $41.50 and $43.00, respectively. The BUCA composite range is $55.92.
The table and chart below present a detailed breakdown of national mean rates and percentile distributions for each payer.
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.