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CPT 90947: Dialysis with Repeated Physician Evaluation
CPT code 90947 denotes a dialysis procedure that requires repeated physician evaluations and may include substantial revision of a dialysis prescription. It covers hemodialysis and continuous renal replacement techniques designed to remove fluid and low–molecular–weight toxins, and references peritoneal dialysis as a home-based option. Nationally, this code is important for accurately capturing physician time and clinical complexity associated with ongoing dialysis management for patients with acute or chronic kidney dysfunction.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clarification of the clinical context for use of 90947, how it differs from single-evaluation dialysis codes, and related CPT procedures to consider when coding dialysis encounters. The publication outlines common clinical indications that prompt repeated physician involvement, such as fluid overload, electrolyte abnormalities, acid–base disturbances, and renal failure requiring adjustment of dialysis prescriptions.
This summary provides operational guidance on the code's purpose and scope, a comparison with related dialysis CPT codes, and highlights topics relevant to billing and clinical documentation. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 90947 describes a dialysis procedure in which blood is filtered through artificial membranes to remove fluid, electrolytes, and other low–molecular–weight toxic substances. This includes modalities performed routinely in thrice-weekly sessions and continuous renal replacement techniques performed more slowly over extended periods. The description specifies peritoneal dialysis as a home-based therapy that the patient can perform, and notes that continuous techniques attempt to mimic native kidney function by providing prolonged clearance.
Service type: Dialysis procedure with repeated physician evaluations and potential prescription revision
Typical site of service: Inpatient or outpatient dialysis centers and, for peritoneal dialysis, the patient's home
National Reimbursement Benchmarks
Medicare’s mean rate of $108.3 stands well below BUCA’s average commercial mean of $266.2, indicating a substantial gap between federal reimbursement and this commercial benchmark for CPT 90947. The Medicare distribution is notably compact with reported quartiles at $105, $107, and $110, reflecting limited variability across localities, while BUCA’s interquartile span centers higher with P25 at $200.8 and P75 at $331.4.
Comparing interquartile spreads (P75–P25) across payers highlights where rates cluster or diverge: Blue Cross Blue Shield shows the widest spread at $164.8, signaling high dispersion, while Aetna’s IQR is $78.0 and Cigna’s is $127.0; UnitedHealth Group has an IQR of $127.8. Medicare is the tightest with an IQR of $5.0, and BUCA’s IQR is $130.6, placing it in the mid-to-high range among commercial payers.