Dialysis

Dialysis is the process uses an artificial kidney (hemodialyzer) to remove waste and extra fluid from the blood. The blood is removed from the body and filtered through the artificial kidney. The filtered blood is then returned to the body with the help of a dialysis machine. Dialysis can be billed once in a calendar month. 

There are two main types of dialysis, hemodialysis and peritoneal dialysis.

  • Hemodialysis uses a machine and a filter to remove waste products and water from the blood. Hemodialysis done 3 sessions per week.
  • Peritoneal dialysis uses a fluid (dialysate) that is placed into the patient’s abdominal cavity to remove waste products and fluid from the body.

Hemodialysis:

The following CPT codes are for hemodialysis. It can be billed under POS 11 or 65

For patients younger than 2 years of age

90951 – End-stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician or other qualified healthcare professional per month

90952 – End-stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 2-3 face-to-face visits by a physician or other qualified healthcare professional per month

90953 – End-stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 1 face-to-face visit by a physician or other qualified health care professional per month

For patients 2-11 years of age

90954 End-stage renal disease (ESRD) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician or other qualified healthcare professional per month

90955 – End-stage renal disease (ESRD) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 2-3 face-to-face visits by a physician or other qualified healthcare professional per month

90956 – End-stage renal disease (ESRD) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 1 face-to-face visit by a physician or other qualified health care professional per month

For patients 12-19 years of age

90957 – End-stage renal disease (ESRD) related services monthly, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician or other qualified healthcare professional per month

90958 – End-stage renal disease (ESRD) related services monthly, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 2-3 face-to-face visits by a physician or other qualified healthcare professional per month

90959 – End-stage renal disease (ESRD) related services monthly, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 1 face-to-face visit by a physician or other qualified health care professional per month

For patients 20 years of age and over

90960 – End Stage Renal disease (ESRD) related services during the course of treatment, for patients 20 years of age and over; with four or more face-to-face physician visits per month

90961 – ESRD related services during the course of treatment, for patients 20 years of age and over; with 2 or 3 face-to-face physician visits per month

90962 – End Stage Renal disease (ESRD) related services during the course of treatment, for patients 20 years of age and over; with one face-to-face physician visit per month.

Peritoneal Dialysis:

The following CPT codes are for full month Peritoneal dialysis

90963 – End-stage renal disease (ESRD) related services for home dialysis per full month, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents 

90964 – End-stage renal disease (ESRD) related services for home dialysis per full month, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents

90965 – End-stage renal disease (ESRD) related services for home dialysis per full month, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth, development, and counseling of parents

90966 End-stage renal disease (ESRD) related services for home dialysis per full month, for patients 20 years of age and older

The following CPT codes are for less than full month Peritoneal dialysis – by day

90967 – End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients younger than 2 years of age

90968 – End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients 2-11 years of age

90969 – End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients 12-19 years of age

90970 – End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients 20 years of age and older

The following CPT codes are for Peritoneal dialysis training

90989 – Dialysis training, complete (bill with quantity 1; $500 allowed)

90993 – Dialysis training, incomplete (enter # of sessions completed for quantity; based on 25 sessions at $20/session for $500)

90993 – Retraining (for a different machine, different dialysis modality, change in setting, or change in dialysis partner; $20/session)

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