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    v1.0.30
    OpenPayerBilling CodesOther Dialysis ProceduresCPT cpt-90999-unlisted-dialysis-procedure
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    CPT 90999: Unlisted Dialysis Procedure

    Commercial payers pay $1299 on average nationally for this procedure.

    CPT code 90999 is an unlisted CPT code used to report dialysis services or procedures that do not have a specific code, typically representing miscellaneous or atypical dialysis-related interventions; the service type is dialysis procedure and the typical site of service is an inpatient or outpatient dialysis unit or hospital setting.

    For related coverage guidance, see recent payer policy updates: Percutaneous Arteriovenous Fistula Creation, Dialysis Services (ESRD) Coverage and Provider Requirements, Total Parenteral Nutrition and Intradialytic Parenteral Nutrition.

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    National Reimbursement Benchmarks

    National commercial rates for CPT 90999 cluster around the BUCA average of $1,299.30, with notable variation by carrier. Blue Cross Blue Shield shows a wide spread between its 75th and 25th percentiles ($543.90 - $298.30 = $245.60), while Aetna’s dispersion is substantially larger ($3,921.40 - $490.60 = $3,430.80) driven by extreme high-end values. UnitedHealth Group and Cigna are at the tight end of the distribution: UnitedHealth Group’s interquartile range is $64.00 - $57.20 = $6.80 and Cigna’s IQR is flat at $220.00 - $220.00 = $0.00, indicating very consistent negotiated levels.

    Comparing central tendency, Aetna’s median ($979.70) sits above BUCA’s mean, whereas Blue Cross Blue Shield’s median ($388.60) and Cigna’s median ($220.00) fall below it; UnitedHealth Group’s median ($60.00) is the lowest. The combination of a moderate BUCA mean with both very tight (Cigna, UnitedHealth Group) and very wide (Aetna, Blue Cross Blue Shield) payer spreads implies pockets of concentrated pricing alongside significant upper-tail variability across the commercial market for this code.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old male with end-stage renal disease (ESRD) is admitted to an inpatient medical ward for acute fluid overload and hyperkalemia after missing outpatient dialysis sessions. The patient requires an urgent dialysis procedure that does not precisely match standard hemodialysis codes due to use of an alternative dialysis modality and additional non-routine resources (for example, urgent acute peritoneal dialysis setup, extended monitoring, or an investigational dialysis procedure). Nephrology evaluates the patient, establishes vascular access or peritoneal access as appropriate, and initiates dialysis. Nursing documents dialysis parameters, ultrafiltration volumes, pre- and post-dialysis weights, and vital sign trends. Orders include electrolyte monitoring and repeat physician assessments for hemodynamic instability or inadequate clearance. Dialysis treatments occur in the hospital dialysis unit, intensive care unit, or swing bed unit depending on acuity and bed availability. Billing uses 90999 to report the dialysis service when no specific CPT code (such as standard in-center hemodialysis codes) applies to the unique procedure or service rendered.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    90935Hemodialysis procedure with single physician evaluationStandard hemodialysis code for a routine treatment with one physician evaluation; used when the dialysis event meets standard hemodialysis clinical definitions rather than an unlisted service.

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    26Modifier 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…
    52Modifier ‑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…
    53Modifier 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…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    91Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…
    99Modifier 99 is a placeholder modifier used when more modifiers apply to a single procedure than the claim form or electronic field allows. The AMA classifies it under Provider Services and Ambulatory…- Use CPT modifier -99 when more modifiers apply to a single procedure line than the claim form or payer field allows (CMS/Noridian: when more than four modifiers are needed); append modifier 99 on…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207RN0300X
    208800000X
    261QM2500X
    324500000X
    227900000X
    207Y00000X
    103TA0400X
    246ZX2200X

    Related ICD-10-CM Codes

    10 rows

    ICD-10-CM CodeDescription
    E83.30Disorder of phosphorus metabolism, unspecified
    E83.39Other disorders of phosphorus metabolism
    E87.20Acidosis, unspecified
    E87.21Acute metabolic acidosis
    E87.22Chronic metabolic acidosis
    E87.29Other acidosis
    E87.5Hyperkalemia
    E87.70Fluid overload, unspecified
    E87.71Transfusion associated circulatory overload
    E87.79Other fluid overload

    Related Payer Policy Updates

    Specialty: Dialysis/Renal Replacement1 / 3

    10 rows

    PolicyPayerEffective Date
    Percutaneous Arteriovenous Fistula CreationAmeriHealth Caritas2026-08-01
    Dialysis Services (ESRD) Coverage and Provider RequirementsMississippi Division of Medicaid2026-08-01
    Total Parenteral Nutrition and Intradialytic Parenteral NutritionCentene2026-05-01
    End Stage Renal Disease (ESRD): Renal Dialysispriority health2026-02-01
    Dialysis services (acute and chronic hemodialysis and peritoneal dialysis)UnitedHealthcare2026-01-01
    Home Hemodialysis (HHD) Coverage Criteriasierra health and life2026-01-01
    Home Hemodialysis (HHD) — Coverage CriteriaUnitedHealthcare2026-01-01
    Staff-Assisted Home HemodialysisCigna2025-11-15
    Parsabiv (etelcalcetide) Coverage for Secondary HyperparathyroidismMolina Healthcare2025-10-09
    DefenCath (taurolidine/heparin catheter lock) CoverageMass General Brigham Health Plan2025-09-01

    Related Codes

    CPT-90989-DIALYSIS-SELF-CARE-TRAINING-COMPLETE-COURSE

    CPT 90989: Dialysis Self-Care and Treatment Training

    CPT-90993-DIALYSIS-SELF-CARE-TRAINING-SESSION

    CPT 90993: Dialysis Self-Care Training Session

    CPT-90997-CHARCOAL-RESIN-HEMOPERFUSION-TOXIN-REMOVAL

    CPT 90997: Blood Detoxification by Charcoal or Resin

    Frequently Asked Questions

    References

    1. 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. 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. 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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    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    90937Hemodialysis procedure requiring repeated evaluationsUsed when multiple physician evaluations are required during a single hemodialysis session; contrasts with 90999 when the procedure is an unlisted dialysis service.
    90945Dialysis procedure other than hemodialysisUsed for non-hemodialysis dialysis modalities that are described by the CPT code; 90999 is used when the specific procedure is not described by existing dialysis codes.
    90947Dialysis procedure other than hemodialysis, requiring repeated evaluationsUsed for repeated physician evaluations during non-hemodialysis modalities; informs selection between specific codes and unlisted code 90999 depending on whether existing codes fit the service.