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CPT 90937: Hemodialysis Procedure with Same-Day E/M Included
CPT code 90937 designates a hemodialysis procedure that includes the dialysis treatment and an associated same-day physician evaluation and management (E/M) service. This code is used nationwide to bill for comprehensive hemodialysis encounters where the treating physician both conducts or supervises dialysis and provides a related clinical assessment on the same day. Its proper use affects payment, clinical documentation, and claims adjudication across acute and outpatient dialysis settings.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for hemodialysis, guidance on typical sites of service, and how this code relates to nearby dialysis procedure codes. The publication summarizes common billing considerations, coding relationships (such as the single-evaluation counterpart), and the set of relevant clinical diagnoses that commonly justify use of the code. It also outlines expected content for claims documentation to support the combined procedure and E/M reporting.
This summary is intended for national audiences including clinicians, billing professionals, and policy analysts who need a clear, practical description of what CPT code 90937 represents and the contexts in which it is applied.
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Billing Code Overview
CPT code 90937 describes a hemodialysis procedure that includes blood removal via an intraarterial or intravenous catheter, filtration through a semipermeable membrane to remove impurities, and return of the cleansed blood to the patient. The code also encompasses a same-day evaluation and management (E/M) service related to the dialysis when performed by the same physician.
Service type: Hemodialysis procedure with physician-performed E/M included
Typical site of service: Dialysis center or hospital dialysis unit
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).