Summary & Overview

HCPCS G0492: Dialysis Evaluation for Acute Kidney Injury

HCPCS Level II code G0492 represents a dialysis procedure that includes a single evaluation by a physician or other qualified health care professional for patients with acute kidney injury who do not have end-stage renal disease. This code captures episodic acute dialysis services distinct from chronic ESRD dialysis billing and is relevant for hospital-based and acute care settings. Nationally, accurate use of G0492 matters for correct clinical reporting, care coordination, and payer adjudication of acute dialysis encounters.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The report outlines how reimbursement and coverage considerations for acute dialysis evaluations are applied across major commercial and federal payers.

Readers will find benchmarks and contextual guidance on clinical and billing distinctions between acute dialysis evaluation and chronic dialysis services, common billing practices tied to single-evaluation encounters, and policy considerations that influence payer coverage and claims processing. The summary also highlights common modifiers and administrative details relevant to billing workflows. Data not available in the input is noted where payer-specific rates, ICD-10 mappings, and related codes would normally appear.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG0492HCPCS Level IIdialysisacute kidney injuryhospital billingprocedural evaluationmedical codingacute care

Billing Code Overview

HCPCS Level II code G0492 describes a dialysis procedure with a single evaluation by a physician or other qualified health care professional for acute kidney injury without end-stage renal disease (ESRD). This service is a procedural dialysis encounter focused on initial evaluation and management tied to acute kidney injury rather than chronic dialysis care.

Service type: Dialysis procedure with single physician or qualified health care professional evaluation
Typical site of service: Hospital inpatient or outpatient dialysis unit, emergency department, or other acute care setting where dialysis for acute kidney injury is provided

Clinical & Coding Specifications

Clinical Context

A 68-year-old hospitalized patient with sepsis and hypotension develops rapidly rising serum creatinine and oliguria consistent with acute kidney injury (AKI). Nephrology is consulted; the patient is hemodynamically unstable and requires urgent hemodialysis. A nephrologist or other qualified health care professional performs a single evaluation and documents the dialysis procedure for AKI without end-stage renal disease (ESRD) during the admission, and the facility bills for the dialysis procedure using G0492. Typical workflow: initial nephrology evaluation and order, placement or use of existing temporary vascular access (e.g., central venous dialysis catheter), performance of the dialysis procedure by qualified staff, one supervising physician or practitioner documents their single evaluation of the dialysis session and the patient’s response, and the procedure is billed with appropriate modifiers for circumstances such as medically complicated service or multiple procedures. Typical site of service is an inpatient acute care hospital or intensive care unit; this code is used when the patient has AKI and is not a chronic dialysis/ESRD patient. Common clinical documentation elements include indication for dialysis (AKI), modality and duration, vascular access type, hemodynamic tolerance, ultrafiltration amount, and supervisory physician encounter note.

Coding Specifications

Modifier	Description	When to Use
`23`	Unusual anesthesia	Use when unusual anesthesia is required for the dialysis procedure (rare).
`52`	Reduced services	Use when the dialysis procedure was partially reduced or not completed.
`53`	Discontinued procedure	Use when dialysis was started but discontinued due to patient instability or complication.
`59`	Data not available in the input.	Data not available in the input.
`62`	Two surgeons	Use when two qualifying physicians equally share responsibility during a complex vascular access or dialysis procedure requiring dual-surgeon involvement.
`66`	Surgical team	Use when a surgical team approach is used for complex access procedures associated with dialysis delivery.
`73`	Discontinued outpatient hospital/ambulatory surgery before anesthesia	Use when an outpatient dialysis attempt is cancelled after preparation but before initiation (rare for inpatient dialysis).
`78`	Unplanned return to the operating/procedure room	Use when patient requires an unplanned return for a dialysis-related surgical procedure or access revision during the same admission.
`80`	Assistant surgeon	Use when an assistant surgeon participates in vascular access placement related to dialysis.
`81`	Minimum assistant surgeon	Use when minimal assistance is provided for access-related procedures.
`82`	Assistant surgeon (when qualified resident not available)	Use when a non-resident assistant surgeon is required for access procedures.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an APP serves as assistant during access placement.
`CO`	Routine home dialysis supervision	Data not available in the input.
`QK`	Medical direction of two, three, or four assistants	Use when the physician directs multiple assistants for a related surgical access procedure.

Taxonomy Code	Specialty	Notes
2080P0200X	Nephrology	Physicians who evaluate and manage AKI and prescribe dialysis.
308000000X	Critical Care Medicine	Intensivists involved when dialysis is provided in the ICU for hemodynamically unstable patients.
2084N0400X	Vascular Surgery	Surgeons who place or revise vascular access when required.
363L00000X	Physician Assistant	APPs who may assist in dialysis procedures and patient management.
363A00000X	Nurse Practitioner	NPs who may perform evaluations and document supervisory dialysis encounters.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N17.9`	Acute kidney failure, unspecified	Direct indication for dialysis in AKI when rapidly progressive azotemia or life-threatening derangements occur.
`N17.0`	Acute kidney failure with tubular necrosis	Common cause of AKI requiring dialysis; documents severity and etiology.
`N17.2`	Acute kidney failure with tubular necrosis, unspecified	Alternative specific AKI code associated with need for dialysis.
`R33.9`	Retention of urine, unspecified	Urinary retention can precipitate post-renal AKI requiring temporary dialysis.
`E86.0`	Dehydration	Volume depletion can cause prerenal AKI and may lead to dialysis in severe cases.
`N18.9`	Chronic kidney disease, unspecified	Used to clarify chronicity; must be excluded to justify AKI-only billing with `G0492`.
`I50.9`	Heart failure, unspecified	Cardiorenal syndrome with volume overload may necessitate dialysis for fluid removal.
`T82.7XXA`	Infection and inflammatory reaction due to other vascular device, initial encounter	Relevant when dialysis access infection complicates dialysis care.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36830`	Venous catheterization for dialysis, non-tunneled central venous dialysis catheter placement	Often performed before `G0492` when urgent vascular access is required for dialysis initiation.
`36556`	Insertion of non-tunneled centrally inserted central venous catheter, age 5 years or older, for dialysis	Alternative code used for placement of temporary dialysis vascular access prior to dialysis session.
`36901`	Insertion of tunneled dialysis catheter, without subcutaneous port or pump, central vein	Used when a tunneled dialysis catheter is placed for ongoing dialysis access and may precede or follow the single evaluation billed with `G0492`.
`90935`	Hemodialysis procedure with single evaluation by a physician or other qualified health care professional, for ESRD patients < age 18 (not directly applicable)	Listed here for context; for adult inpatient AKI without ESRD, `G0492` is the HCPCS Level II code used instead of some ESRD CPT codes.
`90937`	Hemodialysis with partial or reduced services	Used in outpatient dialysis for specific reduced service scenarios; clinically related but billing differs from `G0492`.