CPT 90951: Monthly Pediatric ESRD Care Management

Medicare pays $1214 on average nationally for this procedure.

CPT code 90951 describes the monthly comprehensive management of all services for a patient younger than 2 years with end-stage renal disease (ESRD), requiring the provider to see the patient face-to-face at least four times in the month; this represents a pediatric ESRD monthly care management service provided in an outpatient dialysis or nephrology clinic setting and is billed as a monthly care management encounter for ongoing ESRD treatment coordination and supervision.

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CPT 90951: Monthly Pediatric ESRD Care Management

Medicare pays $1214 on average nationally for this procedure.

Customize your policy alerts

Sign up for cpt 90951 policy alerts

Get alerted when payer policies referencing 90951 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Clinical & Coding Specifications

Clinical Context

A typical patient is an infant under age two with end-stage renal disease (ESRD) receiving monthly comprehensive management from a pediatric nephrologist. The child attends a dialysis center or pediatric hospital where the nephrology provider performs at least four face-to-face encounters during the month to manage dialysis access, fluid and electrolyte balance, growth and nutrition, medication management (including erythropoiesis-stimulating agents, phosphate binders, and antihypertensives), vaccination status, and coordination with nursing, social work, and dietitian services. Monthly visits include assessment of vascular access or peritoneal catheter function, review of dialysis adequacy and ultrafiltration targets, laboratory review (electrolytes, hemoglobin, calcium, phosphorus), adjustment of dialysis prescription or medications, documentation of growth parameters and developmental progress, and caregiver education.

Clinical workflow: The nephrology team schedules recurring monthly visits with flexibility to cluster four face-to-face contacts across outpatient dialysis sessions or clinic visits. Each encounter documents history, focused exam, dialysis and access inspection, review of recent labs, medication and nutrition plan, and care coordination notes. If procedures (e.g., access revision) or hospital-level care occur, those are reported separately. Billing uses 90951 to capture the provider’s management of all monthly ESRD services for the patient younger than two when the required minimum of four face-to-face visits in the month is met.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90935`	Hemodialysis procedure with single evaluation by a physician or other qualified health care professional; for patients under 2 years of age, initial or subsequent inpatient/outpatient hemodialysis	Performed on dialysis days; dialysis procedure codes are billed separately from the monthly management captured by `90951`
`90937`	Hemodialysis procedure requiring repeated evaluation(s) by a physician; for patients under 2 years of age	Used for more complex or repeatedly evaluated hemodialysis encounters in the same day; separate from the monthly management code
`90945`	Hemodiafiltration, olution and replacement; with physician evaluation (pediatric)	Alternative dialysis modality services that are billed in addition to monthly physician management
`90952`	Monthly ESRD-related physician or other qualified health care professional services for patients 2 years of age or older; face-to-face at least four times per month	Related code for age 2 and older; contrasts with `90951` which is specific to patients younger than 2 years
`90989`	End-stage renal disease related services, per diem or other ESRD services (non-specific)	Additional ESRD-related services that may be used for non-monthly or ancillary service reporting depending on payer rules

Related Modifiers

7 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
95	Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…	- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
208000000X	Pediatrics Physician	A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
207RC0000X	Cardiovascular Disease Physician	An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threaten…
363L00000X	Nurse Practitioner	(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
231HA2500X	Assistive Technology Supplier Audiologist	Speech, Language and Hearing Service Providers · Audiologist
2084N0600X	Clinical Neurophysiology Physician	Clinical Neurophysiology is a subspecialty with psychiatric or neurologic expertise in the diagnosis and management of central, peripheral, and autono…
261QR0800X	Recovery Care Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
125Q00000X	Oral Medicine Dentistry	Oral Medicine is the specialty of dentistry responsible for the oral health care of medically complex patients and for the diagnosis and management of…
2086S0120X	Pediatric Surgery Physician	A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents.

Related ICD-10-CM Codes

23 rows

ICD-10-CM Code	Description
D63.1	Anemia in chronic kidney disease
E86.0	Dehydration
E87.1	Hypo-osmolality and hyponatremia
I12.0	Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
I13.0	Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
N17.9	Acute kidney failure, unspecified
N18.4	Chronic kidney disease, stage 4 (severe)
N18.5	Chronic kidney disease, stage 5
N18.6	End stage renal disease
N18.9	Chronic kidney disease, unspecified

Showing 1–10 of 23

Related Payer Policy Updates

Specialty: Dialysis/Renal Replacement1 / 3

10 rows

Policy	Payer	Effective Date
Dialysis Services (ESRD) Coverage and Provider Requirements	Mississippi Division of Medicaid	2026-08-01
Total Parenteral Nutrition and Intradialytic Parenteral Nutrition	Centene	2026-05-01
End Stage Renal Disease (ESRD): Renal Dialysis	priority health	2026-02-01
Home Hemodialysis (HHD) — Coverage Criteria	UnitedHealthcare	2026-01-01
Dialysis services (acute and chronic hemodialysis and peritoneal dialysis)	UnitedHealthcare	2026-01-01
Home Hemodialysis (HHD) Coverage Criteria	sierra health and life	2026-01-01
Staff-Assisted Home Hemodialysis	Cigna	2025-11-15
DefenCath (taurolidine/heparin catheter lock) Coverage	Mass General Brigham Health Plan	2025-09-01
Medical Necessity Guidelines — DefenCath (taurolidine/heparin) catheter lock	Mass General Brigham Health Plan	2025-09-01
Home Hemodialysis (for Idaho Only)	UnitedHealthcare	2025-08-01

CPT 90952: Monthly ESRD Management for Patients <2 Years

CPT-90953-MONTHLY-MANAGEMENT-PEDIATRIC-ESRD

CPT 90953: Monthly ESRD Care for Patients Under 2 Years

CPT-90954-PEDIATRIC-ESRD-MONTHLY-MANAGEMENT

CPT 90954: Monthly ESRD Management for Pediatric Patients Ages 2–11

CPT-90955-PEDIATRIC-MONTHLY-ESRD-MANAGEMENT

CPT 90955: Monthly Management of Pediatric ESRD (ages 2–11)

CPT-90956-PEDIATRIC-ESRD-MONTHLY-MANAGEMENT

CPT 90956: Monthly ESRD Management for Ages 2–11

CPT-90957-MONTHLY-ESRD-MANAGEMENT-ADOLESCENT

CPT 90957: Monthly Management of Adolescent ESRD with ≥4 Face-to-Face Visits

CPT-90958-ESRD-MONTHLY-MANAGEMENT-ADOLESCENT

CPT 90958: Adolescent ESRD Monthly Management, 2–3 Face-to-Face Visits

CPT-90959-MONTHLY-ESRD-MANAGEMENT-ADOLESCENTS

CPT 90959: Monthly Management of Adolescent ESRD

CPT-90960-ESRD-MONTHLY-MANAGEMENT-ADULT

CPT 90960: Monthly Management for Adult ESRD with ≥4 Face-to-Face Visits

CPT-90961-ESRD-MONTHLY-MANAGEMENT-FACE-TO-FACE

CPT 90961: ESRD Monthly Management, Face-to-Face 2–3 Visits

Showing 1–10 of 19

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90935`	Hemodialysis procedure with single evaluation by a physician or other qualified health care professional; for patients under 2 years of age, initial or subsequent inpatient/outpatient hemodialysis	Performed on dialysis days; dialysis procedure codes are billed separately from the monthly management captured by `90951`
`90937`	Hemodialysis procedure requiring repeated evaluation(s) by a physician; for patients under 2 years of age	Used for more complex or repeatedly evaluated hemodialysis encounters in the same day; separate from the monthly management code
`90945`	Hemodiafiltration, olution and replacement; with physician evaluation (pediatric)	Alternative dialysis modality services that are billed in addition to monthly physician management
`90952`	Monthly ESRD-related physician or other qualified health care professional services for patients 2 years of age or older; face-to-face at least four times per month	Related code for age 2 and older; contrasts with `90951` which is specific to patients younger than 2 years
`90989`	End-stage renal disease related services, per diem or other ESRD services (non-specific)	Additional ESRD-related services that may be used for non-monthly or ancillary service reporting depending on payer rules

Related Modifiers

7 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
95	Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…	- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
208000000X	Pediatrics Physician	A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
207RC0000X	Cardiovascular Disease Physician	An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threaten…
363L00000X	Nurse Practitioner	(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
231HA2500X	Assistive Technology Supplier Audiologist	Speech, Language and Hearing Service Providers · Audiologist
2084N0600X	Clinical Neurophysiology Physician	Clinical Neurophysiology is a subspecialty with psychiatric or neurologic expertise in the diagnosis and management of central, peripheral, and autono…
261QR0800X	Recovery Care Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
125Q00000X	Oral Medicine Dentistry	Oral Medicine is the specialty of dentistry responsible for the oral health care of medically complex patients and for the diagnosis and management of…
2086S0120X	Pediatric Surgery Physician	A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents.

Related ICD-10-CM Codes

23 rows

ICD-10-CM Code	Description
D63.1	Anemia in chronic kidney disease
E86.0	Dehydration
E87.1	Hypo-osmolality and hyponatremia
I12.0	Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
I13.0	Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
N17.9	Acute kidney failure, unspecified
N18.4	Chronic kidney disease, stage 4 (severe)
N18.5	Chronic kidney disease, stage 5
N18.6	End stage renal disease
N18.9	Chronic kidney disease, unspecified

Showing 1–10 of 23

Related Payer Policy Updates

Specialty: Dialysis/Renal Replacement1 / 3

10 rows

Policy	Payer	Effective Date
Dialysis Services (ESRD) Coverage and Provider Requirements	Mississippi Division of Medicaid	2026-08-01
Total Parenteral Nutrition and Intradialytic Parenteral Nutrition	Centene	2026-05-01
End Stage Renal Disease (ESRD): Renal Dialysis	priority health	2026-02-01
Home Hemodialysis (HHD) — Coverage Criteria	UnitedHealthcare	2026-01-01
Dialysis services (acute and chronic hemodialysis and peritoneal dialysis)	UnitedHealthcare	2026-01-01
Home Hemodialysis (HHD) Coverage Criteria	sierra health and life	2026-01-01
Staff-Assisted Home Hemodialysis	Cigna	2025-11-15
DefenCath (taurolidine/heparin catheter lock) Coverage	Mass General Brigham Health Plan	2025-09-01
Medical Necessity Guidelines — DefenCath (taurolidine/heparin) catheter lock	Mass General Brigham Health Plan	2025-09-01
Home Hemodialysis (for Idaho Only)	UnitedHealthcare	2025-08-01

CPT 90952: Monthly ESRD Management for Patients <2 Years

CPT-90953-MONTHLY-MANAGEMENT-PEDIATRIC-ESRD

CPT 90953: Monthly ESRD Care for Patients Under 2 Years

CPT-90954-PEDIATRIC-ESRD-MONTHLY-MANAGEMENT

CPT 90954: Monthly ESRD Management for Pediatric Patients Ages 2–11

CPT-90955-PEDIATRIC-MONTHLY-ESRD-MANAGEMENT

CPT 90955: Monthly Management of Pediatric ESRD (ages 2–11)

CPT-90956-PEDIATRIC-ESRD-MONTHLY-MANAGEMENT

CPT 90956: Monthly ESRD Management for Ages 2–11

CPT-90957-MONTHLY-ESRD-MANAGEMENT-ADOLESCENT

CPT 90957: Monthly Management of Adolescent ESRD with ≥4 Face-to-Face Visits

CPT-90958-ESRD-MONTHLY-MANAGEMENT-ADOLESCENT

CPT 90958: Adolescent ESRD Monthly Management, 2–3 Face-to-Face Visits

CPT-90959-MONTHLY-ESRD-MANAGEMENT-ADOLESCENTS

CPT 90959: Monthly Management of Adolescent ESRD

CPT-90960-ESRD-MONTHLY-MANAGEMENT-ADULT

CPT 90960: Monthly Management for Adult ESRD with ≥4 Face-to-Face Visits

CPT-90961-ESRD-MONTHLY-MANAGEMENT-FACE-TO-FACE

CPT 90961: ESRD Monthly Management, Face-to-Face 2–3 Visits

Showing 1–10 of 19

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 90951: Monthly Pediatric ESRD Care Management

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OpenPayer

CPT 90951: Monthly Pediatric ESRD Care Management

Sign up for cpt 90951 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

References

CPT 90951: Monthly Pediatric ESRD Care Management

Sign up for cpt 90951 policy alerts

CPT 90951: Monthly Pediatric ESRD Care Management

Sign up for cpt 90951 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What does CPT 90951 describe?

How many face-to-face encounters are required in the month to bill 90951?

How does 90951 relate to dialysis procedure codes like 90935 or 90937?

Which related CPT code should be used for patients aged 2 years or older?

What diagnoses commonly support billing of 90951 on a claim?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What does CPT 90951 describe?

How many face-to-face encounters are required in the month to bill 90951?

How does 90951 relate to dialysis procedure codes like 90935 or 90937?

Which related CPT code should be used for patients aged 2 years or older?

What diagnoses commonly support billing of 90951 on a claim?

References