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.

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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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CPT 90999: Unlisted Dialysis Procedure

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

Customize your policy alerts

Sign up for cpt 90999 policy alerts

Get alerted when payer policies referencing 90999 are released or updated.

Monitor payer policy activity

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

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

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 Code	Description	Relationship to This Procedure
`90935`	Hemodialysis procedure with single physician evaluation	Standard 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.
`90937`	Hemodialysis procedure requiring repeated evaluations	Used when multiple physician evaluations are required during a single hemodialysis session; contrasts with `90999` when the procedure is an unlisted dialysis service.
`90945`	Dialysis procedure other than hemodialysis	Used 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.
`90947`	Dialysis procedure other than hemodialysis, requiring repeated evaluations	Used 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.

Related Modifiers

7 rows

Modifier	Description	When to Use
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…
59	Modifier 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…
76	Modifier -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…
91	Modifier 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…
99	Modifier 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	Specialty	Notes
207RN0300X	Nephrology Physician	An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not fu…
208800000X	Urology Physician	A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has compreh…
261QM2500X	Medical Specialty Clinic/Center	An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical s…
324500000X	Substance Abuse Rehabilitation Facility	A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the tre…
227900000X	Registered Respiratory Therapist	A Registered Respiratory Therapist (RRT) is an advanced therapist who has passed standardized written and clinical simulation examinations administere…
207Y00000X	Otolaryngology Physician	An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ea…
103TA0400X	Addiction (Substance Use Disorder) Psychologist	A psychologist with a proficiency that involves the application of psychological treatment of addiction stemming from the use of alcohol and other psy…
246ZX2200X	Orthopedic Assistant	An Orthopaedic Assistant is a person who has been trained to work as a physician extender in both clinical and surgical environments. An Orthopaedic A…

Related ICD-10-CM Codes

10 rows

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

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.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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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.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90935`	Hemodialysis procedure with single physician evaluation	Standard 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.
`90937`	Hemodialysis procedure requiring repeated evaluations	Used when multiple physician evaluations are required during a single hemodialysis session; contrasts with `90999` when the procedure is an unlisted dialysis service.
`90945`	Dialysis procedure other than hemodialysis	Used 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.
`90947`	Dialysis procedure other than hemodialysis, requiring repeated evaluations	Used 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.

Related Modifiers

7 rows

Modifier	Description	When to Use
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…
59	Modifier 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…
76	Modifier -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…
91	Modifier 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…
99	Modifier 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	Specialty	Notes
207RN0300X	Nephrology Physician	An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not fu…
208800000X	Urology Physician	A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has compreh…
261QM2500X	Medical Specialty Clinic/Center	An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical s…
324500000X	Substance Abuse Rehabilitation Facility	A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the tre…
227900000X	Registered Respiratory Therapist	A Registered Respiratory Therapist (RRT) is an advanced therapist who has passed standardized written and clinical simulation examinations administere…
207Y00000X	Otolaryngology Physician	An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ea…
103TA0400X	Addiction (Substance Use Disorder) Psychologist	A psychologist with a proficiency that involves the application of psychological treatment of addiction stemming from the use of alcohol and other psy…
246ZX2200X	Orthopedic Assistant	An Orthopaedic Assistant is a person who has been trained to work as a physician extender in both clinical and surgical environments. An Orthopaedic A…

Related ICD-10-CM Codes

10 rows

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

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.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 90999: Unlisted Dialysis Procedure

Sign up for cpt 90999 policy alerts

National Reimbursement Benchmarks

OpenPayer

CPT 90999: Unlisted Dialysis Procedure

Sign up for cpt 90999 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

References

CPT 90999: Unlisted Dialysis Procedure

Sign up for cpt 90999 policy alerts

National Reimbursement Benchmarks

CPT 90999: Unlisted Dialysis Procedure

Sign up for cpt 90999 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

When should I use CPT 90999 instead of a standard dialysis CPT code?

What supporting documentation is needed when submitting a claim with 90999?

Which modifiers are commonly associated with 90999 and when are they used?

What does the payer benchmark data show about reimbursement variability for 90999?

How does 90999 relate to other dialysis CPT codes like 90935, 90937, 90945, and 90947?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

When should I use CPT 90999 instead of a standard dialysis CPT code?

What supporting documentation is needed when submitting a claim with 90999?

Which modifiers are commonly associated with 90999 and when are they used?

What does the payer benchmark data show about reimbursement variability for 90999?

How does 90999 relate to other dialysis CPT codes like 90935, 90937, 90945, and 90947?

References