Summary & Overview
CPT 90964: Home Dialysis Monthly Management for Pediatric ESRD
CPT code 90964 represents monthly provider management of all provider-related services for pediatric patients aged 2 to 11 receiving home dialysis for end stage renal disease (ESRD). This code captures the ongoing clinical oversight, coordination, and management activities that support chronic dialysis delivered in the home setting for young children — an important area of pediatric nephrology care as home modalities expand and clinical teams manage complex, long-term needs.
Key payers included in this national review are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what the code covers clinically, the typical site of service, and the population it serves. The publication also summarizes payer coverage patterns, billing considerations, and common modifiers used with this service (modifiers list provided in input). Where available, benchmarks and policy updates that affect reimbursement and authorization for pediatric home dialysis management are summarized to help coding, billing, and clinical teams align documentation and claims with payer expectations.
This national overview is intended to clarify clinical scope and administrative context for CPT code 90964, helping health system leaders, coders, and clinicians understand the role of this monthly management code in pediatric ESRD home care.
Billing Code Overview
CPT code 90964 describes management of all provider-related services for one full month for the home dialysis care of a patient aged 2 to 11 years with end stage renal disease (ESRD).
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Service type: Monthly comprehensive provider management for pediatric home dialysis
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Typical site of service: Home-based dialysis care for pediatric patients
Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A typical patient is a pediatric child aged 2–11 years with end stage renal disease (ESRD) established on home dialysis (peritoneal dialysis or home hemodialysis). The provider manages all provider-related services for the full calendar month, coordinating dialysis prescriptions, monitoring growth and development, reviewing laboratory and dialysis adequacy data, adjusting medications (including erythropoiesis-stimulating agents, phosphate binders, and antihypertensives), and supervising vascular or peritoneal access care. The clinical workflow includes an initial monthly comprehensive review of the patient’s home dialysis records, remote or in-person assessment of the child and caregiver technique, documentation of monthly weights, fluid status, and blood pressures, review of monthly serum chemistries and dialysis adequacy metrics, communication with the dialysis nursing team and durable medical equipment suppliers, medication reconciliation, and arranging or documenting any necessary interventions (for example, access revisions or hospital transfers). The provider documents time interval (one full month of care), elements of management, any significant changes in condition, and coordination activities to support use of 90964 for the monthly home dialysis management service for a pediatric ESRD patient.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard reporting when no modifier is applicable |