CPT Code 90945: Dialysis Procedure Other Than Hemodialysis

Learn how to accurately report CPT code 90945 for dialysis procedures other than hemodialysis, including documentation tips and billing guidelines.

Use Code

What is dialysis other than hemodialysis?

CPT code 90945 is used to report dialysis procedures other than hemodialysis, such as peritoneal dialysis or continuous renal replacement therapies (CRRT). This code is part of a group of dialysis services and procedures commonly billed for patients with end-stage renal disease (ESRD) or acute kidney failure who require renal support not involving traditional hemodialysis.

These miscellaneous dialysis services include first-visit CRRT (90945) and are distinct from codes like 90937 for second-visit hemodialysis, making accurate reporting essential for appropriate reimbursement. Healthcare providers must document 3 dialysis notes per month and track first and second visit designations, especially when submitting claims for outpatient dialysis.

CPT code 90945, maintained by the American Medical Association, covers the physician component of the service, including evaluation, dialysis prescription, and clinical oversight. When billing, attention to the place of service, use of modifiers (e.g., XE), and documentation supporting dialysis procedure type is critical, especially under scrutiny from Recovery Audit Contractors (RACs) or Medicare Administrative Contractors (MACs).

Since ESRD patients often undergo repeated evaluations, dialysis services outside standard hemodialysis settings require detailed justification for both dialysis facility billing and physician charges, ensuring qualified health care professionals remain compliant with CMS coverage guidelines.

CPT code 90945 documentation requirements

To report the 90945 CPT code accurately, healthcare providers must ensure documentation supports medical necessity and the dialysis procedure performed. The following elements should be recorded:

Clinical indication and specific type of dialysis services provided (e.g., continuous ambulatory peritoneal dialysis, continuous cycling peritoneal dialysis, or continuous renal replacement therapy)
Patient evaluation findings, including changes in condition or ESRD-related symptoms.
Any adjustments to treatment, such as dialysate volume, frequency, or modality.
Notation of interventions or referrals (e.g., to a vascular surgeon or dietitian).
Confirmation that only one evaluation was performed by the qualified health care professional during the applicable week.
Supporting notes must be included in the dialysis record or outpatient visit summary, especially for ESRD patients receiving dialysis services and procedures outside routine hemodialysis.

This level of documentation helps ensure appropriate reimbursement, especially under audits by RACs or MACs.

CPT code 90945 billing guidelines

CPT code 90945 is used to report a dialysis procedure other than hemodialysis, such as peritoneal dialysis or continuous renal replacement therapies. It is billed once per week when only one evaluation occurs.

It should not be reported with 90935 (for hemodialysis) or 90947 (for multiple hemodialysis visits). This code also cannot be billed on the same date as monthly management codes like 90960–90962, which are used for end-stage renal disease care.

To ensure appropriate reimbursement, healthcare providers must check payer policies to confirm coverage for different dialysis services and procedures, especially when billing dialysis services outside of hemodialysis.

Modifiers like XE may be required if the service was performed during a separate encounter. Thorough documentation is essential, especially with RACs and MACs increasingly reviewing ESRD claims.

Other relevant CPT codes

90947: Peritoneal dialysis with multiple physician evaluations
90935: Hemodialysis with single visit
90960–90962: Monthly management of ESRD

Frequently asked questions

No. CPT code 90945 is limited to one evaluation per week per patient for dialysis services and procedures other than hemodialysis.

No. For hemodialysis, use CPT codes 90935 (single visit) or 90937 (multiple visits).

Yes, as long as a physician or qualified healthcare provider evaluates the ESRD patient during the treatment week for peritoneal dialysis or another miscellaneous dialysis service.