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CPT 90945: Evaluation and Selection of Non-Hemodialysis Modality
CPT code 90945 denotes a clinical evaluation in which a provider assesses a patient and selects a dialysis method other than hemodialysis. The code captures physician or qualified professional time and clinical decision-making around initiating or changing non-hemodialysis modalities such as peritoneal dialysis. Nationally, this code is relevant because it documents modality-specific planning for patients with advanced kidney disease and supports appropriate care coordination and billing for non-hemodialysis dialysis management.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for modality selection, common diagnostic scenarios when 90945 applies (including end-stage renal disease and acute or chronic kidney failure), and how this code relates to other dialysis procedure codes used for ongoing dialysis care. The publication also summarizes typical sites of service where the evaluation occurs and highlights associated service lines and clinical taxonomies.
This resource is designed to inform billing, coding, and clinical administrative teams about the role of 90945 in documenting non-hemodialysis modality evaluations, clarifying when the code is used and how it fits within the broader dialysis coding landscape.
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Billing Code Overview
CPT code 90945 describes a physician or qualified provider evaluation that results in selection of a dialysis method other than hemodialysis. The service is an evaluation and decision-making visit focused on determining an appropriate dialysis modality (for example, peritoneal dialysis or other non-hemodialysis techniques).
Service Type: Dialysis modality evaluation (non-hemodialysis)
Typical Site of Service: Hospital inpatient or outpatient dialysis clinic, outpatient hospital department, or ambulatory care setting
National Reimbursement Benchmarks
Medicare averages $79.10 for CPT 90945, which sits well below BUCA’s commercial mean of $221.30. This gap of $142.20 highlights a substantial divergence between federal program reimbursement and this commercial benchmark, with BUCA nearly three times Medicare’s mean and indicating stronger commercial valuation for this service.
Examining dispersion (P75 minus P25) across payers highlights variability in commercial contracting. Blue Cross Blue Shield has the widest interquartile spread at $149.00 ($348.50 - $195.60), followed by BUCA at $121.00 ($265.50 - $145.30) and UnitedHealth Group at $82.20 ($171.10 - $85.90). Aetna shows a relatively tight spread of $55.00 ($119.00 - $64.00), and Cigna’s spread is $86.60 ($174.10 - $85.50), indicating Aetna is the tightest and Blue Cross Blue Shield the widest among these payers.