CPT 90937: Hemodialysis Procedure with Repeated Evaluations
Medicare pays $90 and commercial payers pay $286 on average nationally for this procedure.
CPT code 90937 describes a hemodialysis procedure requiring repeated evaluations in which blood is removed via an arterial or venous access, filtered through a semipermeable membrane to remove waste, and returned to the patient; the service typically represents an ongoing dialysis treatment session with repeated clinician assessments and is commonly provided in hospital outpatient dialysis units or freestanding dialysis centers (service type: hemodialysis procedure; typical site of service: outpatient dialysis unit or dialysis center).
For related coverage guidance, see recent payer policy updates: Dialysis Services (ESRD) Coverage and Provider Requirements, Total Parenteral Nutrition and Intradialytic Parenteral Nutrition, End Stage Renal Disease (ESRD): Renal Dialysis.
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National Reimbursement Benchmarks
Medicare’s mean rate of $90.4 sits well below BUCA’s average commercial mean of $285.6, indicating a substantial gap between government and this commercial benchmark for CPT 90937. The median for Medicare is $90 and its interquartile band is narrow ($88 to $92), underscoring consistency across localities, while BUCA’s interquartile span ($238 to $324) reflects materially higher typical commercial pricing.
Examining dispersion using P75 minus P25, Blue Cross Blue Shield shows the widest IQR at $80.3 ($431.1 - $350.8), followed by UnitedHealth Group at $101.1 ($210.7 - $109.6) and Cigna at $110.2 ($219.2 - $109.0); BUCA’s IQR is $85.9 ($323.5 - $237.6). Aetna has one of the tighter spreads at $16.0 ($110.0 - $41.6), and Medicare is the tightest at $4.0 ($92 - $88).