Summary & Overview
CPT 0692T: Therapeutic Ultrafiltration for Volume Overload
CPT code 0692T denotes therapeutic ultrafiltration: an extracorporeal procedure that removes excess intravascular fluid, frequently used for patients with heart failure and refractory volume overload. Nationally, this code matters because it captures a resource-intensive, device-dependent intervention with implications for acute care utilization, length of stay, and post-acute management.
Major national payers included in analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the service definition and typical sites of care, plus context on clinical indications and operational considerations. The publication summarizes reimbursement benchmarks and payer coverage patterns where available, highlights coding and billing considerations tied to procedural reporting, and outlines clinical context for use in heart failure and volume management.
This overview provides clinical and operational readers with the essential facts about procedure definition, expected care settings, and the payer landscape. It is intended to support coding accuracy, billing workflows, and administrative planning for facilities and clinicians that provide extracorporeal fluid removal.
Billing Code Overview
CPT code 0692T describes a therapeutic ultrafiltration procedure in which the provider uses an ultrafiltration machine to remove excess fluid from a patient, commonly applied for patients with heart failure experiencing volume overload. The procedure is a form of extracorporeal fluid removal intended to reduce congestive symptoms and improve hemodynamic status.
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Service type: Therapeutic ultrafiltration (extracorporeal fluid removal)
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Typical site of service: Hospital inpatient, hospital outpatient department, or ambulatory procedure center where extracorporeal equipment and monitoring are available.
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Clinical & Coding Specifications
Clinical Context
A 72-year-old male with chronic systolic heart failure (left ventricular ejection fraction 30%) presents with progressive dyspnea, orthopnea, and peripheral edema refractory to escalated oral diuretic therapy. The patient has evidence of volume overload with bibasilar crackles and 4+ pitting edema. Hospital evaluation demonstrates worsening renal function limiting loop diuretic escalation and persistent congestion despite intravenous diuretics. The cardiology team determines the patient is a candidate for ultrafiltration to remove excess intravascular and interstitial fluid.
The clinical workflow includes pre-procedure evaluation (consent, vascular access planning, baseline weights, vital signs, basic labs including BMP and CBC), placement of temporary vascular access, connection to an ultrafiltration device, monitoring of fluid removal rate and hemodynamics during the procedure, serial assessments of urine output and renal function, documentation of fluid removed and clinical response, and post-procedure vascular access removal with observation for complications. Typical duration varies by prescribed fluid removal goals and patient tolerance. This service is commonly delivered in an inpatient hospital setting or an acute care observation unit for patients with decompensated heart failure.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the procedure required substantially greater work than usual due to complexity or complications. |
23 | Unusual anesthesia | Use when general anesthesia is medically necessary and not typically used for the procedure. |
52 | Reduced services | Use when ultrafiltration is started but discontinued early and substantially reduced from typical service. |
53 | Discontinued procedure | Use when the procedure is terminated due to extenuating circumstances or patient safety. |
62 | Two surgeons | Use when two surgeons of different specialties are required for provider-level management of access or complications. |
66 | Surgical team | Use when a surgical team performs the procedure per payer policy requiring team reporting. |
73 | Discontinued outpatient procedure prior to anesthesia | Use when outpatient ultrafiltration is cancelled after patient preparation but before anesthesia or sedation initiation. |
78 | Unplanned return to OR/procedure following initial service | Use when patient requires immediate return for management of a complication related to the ultrafiltration session. |
80 | Assistant surgeon | Use when an assistant surgeon is documented and billed in accordance with payer rules. |
82 | Assistant surgeon (when qualified resident unavailable) | Use when an assistant surgeon is used because a qualified resident is not available. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for surgical procedures (Medicare) | Use when a qualifying non-physician practitioner performs allowable portions of the service under supervision. |
QK | Medical direction of two, three, or four CRNAs or anesthetists | Use when medical direction for anesthesia staff is provided as required. |
QX | CRNA service: personally performed | Use when a CRNA personally performs anesthesia or sedation services associated with the procedure. |
QY | Medical direction of one CRNA by an anesthesiologist | Use when an anesthesiologist medically directs one CRNA during the procedure. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 2084P0800X | Cardiology | Interventional and heart failure cardiologists frequently manage ultrafiltration in decompensated heart failure. |
| 208000000X | Internal Medicine | Hospitalist or internist oversight for inpatient procedures and medical management. |
| 207RC0000X | Critical Care Medicine | Intensivists manage ultrafiltration in hemodynamically unstable patients in ICU. |
| 208100000X | Nephrology | Nephrologists provide expertise in fluid management and vascular access for ultrafiltration in select cases. |
| 101YA0400X | Vascular Surgery | Vascular surgeons may be involved for complex access placement or complication management. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
I50.23 | Acute on chronic systolic (congestive) heart failure | Common indication for ultrafiltration when volume overload is refractory to diuretics. |
I50.33 | Acute on chronic diastolic (congestive) heart failure | Volume overloaded patients with preserved ejection fraction may require ultrafiltration when diuresis fails. |
I50.9 | Heart failure, unspecified | Used when heart failure is primary driver of decompensation and fluid removal is indicated. |
N17.9 | Acute kidney failure, unspecified | Worsening renal function that limits diuretic response can make ultrafiltration a therapeutic option; requires close monitoring. |
E87.70 | Fluid-electrolyte balance disorder, unspecified | Electrolyte and volume abnormalities are relevant to planning and monitoring ultrafiltration. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
36556 | Placement of non-tunneled centrally inserted central venous catheter, age 5 years or older | Often used to obtain temporary vascular access for ultrafiltration sessions when peripheral access is inadequate. |
36600 | Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure) | Used when continuous arterial pressure monitoring is required during ultrafiltration in unstable patients. |
99223 | Initial hospital care, typically 70 minutes or more | Used for intensive initial inpatient evaluation and management of a patient admitted for decompensated heart failure requiring ultrafiltration. |
94010 | Breathing capacity test for therapy management (spirometry) — (note: alternative respiratory testing codes may apply) | May be performed as part of pre- and post-procedure respiratory assessment in patients with pulmonary congestion. |
76937 | Ultrasound guidance for vascular access (initial vessel) | Used when ultrasound guidance is employed for central venous catheter placement for ultrafiltration access. |