CPT Code 90935: Hemodialysis Procedure with Single Evaluation

What is hemodialysis with single evaluation?

Hemodialysis is a life-sustaining treatment used in end-stage renal disease (ESRD) or advanced chronic kidney disease. It involves filtering waste, excess fluid, and toxins from the blood when the kidneys can no longer perform these functions. The patient’s blood is drawn through a catheter, circulated through a dialysis machine, cleaned via dialysis machine filters, and then returned to the body.

This process helps manage symptoms such as fluid overload, electrolyte imbalance, and high blood pressure. A single evaluation refers to one documented, medically necessary provider visit during the week’s dialysis schedule. This is different from repeated evaluations, which involve multiple assessments and require different codes.

Methods of hemodialysis include in-center, home dialysis, and nocturnal dialysis. The treatment is often part of a broader plan involving dialysis training, patient education, and eventual kidney transplantation when eligible.

CPT code 90935 documentation requirements

Clear documentation is essential for ensuring appropriate reimbursement when billing CPT 90935. It must demonstrate the provider's involvement in care during the dialysis session.

A medically necessary visit during dialysis

The record must show that a qualified healthcare professional conducted a face-to-face evaluation during the dialysis treatment that was medically necessary and related to dialysis care.

Evaluation findings

Document clinical findings such as blood pressure, weight, access site status, and fluid status. This helps support the need for the evaluation and guides changes in care.

Dialysis parameters reviewed

Note that the provider reviewed or modified the dialysis prescription, discussed access function, electrolyte balance, and any issues related to the dialysis machine or treatment process.

Care plan adjustments

If the evaluation led to a change in treatment—such as medication adjustments, dietary counseling, or vascular access planning—this must be documented clearly.

Visit date and weekly frequency

Specify the date of dialysis and confirm that this was the only evaluation performed by the billing provider that week. Multiple visits require the use of different codes such as 90937 or 90960–90962.

CPT code 90935 billing guidelines

Understanding the billing rules for CPT 90935 ensures compliance and reduces the risk of denials. Below are the main guidelines.

Bill only for a single evaluation in the week

Use CPT 90935 when the provider performs only one documented evaluation for the dialysis patient in a single calendar week. It includes all services typically provided during that session.

Do not use with multiple weekly visits

If the provider sees the patient more than once in a week, report 90937 or monthly dialysis management codes (90960–90962), depending on the number and nature of evaluations.

Use only for hemodialysis procedures

CPT 90935 applies exclusively to hemodialysis procedures. For peritoneal dialysis services, use CPT 90945, which has its own billing rules and evaluation requirements.

Follow payer and specialty requirements

Some payers may require the provider to be a nephrologist or supervising physician to report CPT 90935. Others may allow billing by healthcare providers managing patients in dialysis centers under supervision.

Applicable modifiers for CPT code 90935

Depending on the setting and nature of the service, the following modifiers may apply to CPT 90935:

• Modifier 25: Use when a separate, unrelated evaluation and management service is performed on the same day and is supported by medical necessity.
• Modifier 59: Indicates a distinct procedural service if other unrelated services are performed on the same day. Use cautiously and only if necessary.
• Modifier GT: For telemedicine services, when the face-to-face evaluation was conducted via virtual platform. Payer policies vary on this.
• Modifier PO: Used to report that the service was rendered in a hospital outpatient department. This may be required on facility claims.

Other relevant CPT codes

Several related CPT codes are used in the management and monitoring of dialysis patients. These may apply when evaluations occur more than once per week or involve other dialysis modalities:

• 90937: Hemodialysis procedure with repeated evaluations during the week. Used when the provider sees the patient more than once in a 7-day period.
• 90940: Hemodialysis access flow study to determine blood flow in grafts and arteriovenous fistulae by an indicator method
• 90960: Monthly dialysis management for patients requiring 4 or more visits per month.
• 90961: Monthly dialysis management for 2–3 visits in a calendar month.
• 90962: Monthly dialysis management for patients needing 1 visit per month.
• 90945: Peritoneal dialysis procedure with a single physician evaluation. Use for patients receiving peritoneal dialysis, not hemodialysis.