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: