Summary & Overview
CPT 90953: Monthly Management of Pediatric End Stage Renal Disease
CPT code 90953 denotes monthly comprehensive face-to-face management of a child under 2 years with end stage renal disease (ESRD). This code captures the clinician’s coordination and oversight of all monthly services required for ongoing pediatric ESRD care. Given the high resource needs and complex care coordination for infants with ESRD, accurate use of this code affects national measurement of pediatric dialysis and transplant care delivery.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines where 90953 applies clinically, expected sites of service, and payer coverage considerations.
Readers will find national benchmarks and context for utilization and reimbursement patterns, summaries of relevant policy and coding guidance updates affecting monthly ESRD management, and clinical context describing the scope of services typically encompassed by the code. The report also highlights common billing modifiers and implementation considerations for multi-disciplinary teams caring for infants with ESRD. Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Billing Code Overview
CPT code 90953 describes monthly comprehensive management of all services for a patient younger than 2 years with end stage renal disease (ESRD). The service requires the provider to see the patient face-to-face one time during the month to coordinate and manage ongoing ESRD care.
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Service type: Monthly comprehensive management of pediatric ESRD
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Typical site of service: Outpatient clinic or dialysis center visit for face-to-face monthly management
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A realistic scenario is an infant aged 18 months with congenital anomalies of the kidney leading to end-stage renal disease (ESRD) who is established on peritoneal dialysis and requires monthly multidisciplinary management. The pediatric nephrologist schedules a single, face-to-face monthly visit in the pediatric dialysis clinic to assess growth, dialysis adequacy, vascular or catheter site status, fluid and electrolyte balance, medication reconciliation (including erythropoiesis-stimulating agents and phosphate binders), immunization status, nutritional needs, and caregiver education. During the encounter the provider documents a review of home dialysis logs, recent laboratory results (electrolytes, BUN/creatinine, hemoglobin), weight and growth percentile tracking, change in dialysis prescription if needed, and coordination with social work, nutrition, and transplant evaluation services. The visit is billed under 90953 to reflect the provider’s management of all monthly services for a patient younger than 2 years with ESRD, with one face-to-face visit per month to accomplish this coordinated care.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the physician professional component is billed separately from technical services. |