2025 CPT code 90962
(Active) Effective Date: N/A Revision Date: N/A Medicine - End-Stage Renal Disease (ESRD) Services Medicine Services and Procedures > Dialysis Services and Procedures Feed
Monthly ESRD-related services for patients aged 20 and older, involving one face-to-face physician visit.
Modifiers may apply depending on the specific circumstances of service.Refer to the CPT® manual for guidance on appropriate modifier use.
Medical necessity is established by the presence of ESRD and the need for ongoing management of the patient's condition. The number of visits should be medically justified based on the patient's clinical status and requirements.
The physician or other qualified healthcare professional manages all outpatient ESRD-related services for a month, including scheduled and episodic exams, dialysis schedule adjustments, oversight of dialysis visits, lab test review, medication management, care planning, communication with the patient, and care coordination and support.
- Medicine Services and Procedures > Dialysis Services and Procedures
- Medicine Services and Procedures > Dialysis Services and Procedures
In simple words: This code covers a doctor's monthly care for someone 20 or older with severe kidney disease (ESRD).The doctor sees the patient once during the month to manage their care, which includes regular checkups, managing their dialysis schedule, reviewing tests, and providing support.
This code encompasses comprehensive management of outpatient ESRD-related services for a patient aged 20 or older over a one-month period.It includes scheduled and episodic examinations for disease management; establishing and adjusting the patient's dialysis schedule and prescription; overseeing each dialysis visit; reviewing lab tests; addressing medication and supplement needs; developing short- and long-term care plans; handling telephone and electronic communications; and coordinating care, counseling, and support for the patient and/or caregivers.The service involves one face-to-face visit during the month.
Example 1: A 65-year-old patient with ESRD receives a complete assessment and one face-to-face visit during the month for management of their dialysis. Code 90962 is reported., A 25-year-old ESRD patient has a single face-to-face visit during the month for disease management, including reviewing lab results and adjusting medication.Code 90962 applies., A 40-year-old ESRD patient receives a complete assessment and several follow-up contacts (phone calls, emails) during the month, with one in-person visit. Code 90962 is reported, with other communication services billed separately if applicable.
Detailed documentation should include the date(s) of service, patient's age and diagnosis (ESRD), the number of face-to-face visits, a description of services provided (e.g., exam, lab review, medication adjustments, care planning, communication), and confirmation that a complete assessment was conducted during the month.
** This code is for outpatient services only.For inpatient services, use codes 90935-90937.This code does not include dialysis treatment; dialysis procedures are billed separately.
- Revenue Code: P9A (Dialysis Services)
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Nephrology
- Place of Service:Office, Clinic