2025 CPT code 90963
(Active) Effective Date: N/A Revision Date: N/A Medicine - ESRD-related services for home dialysis Medicine Services and Procedures > Dialysis Services and Procedures Feed
Comprehensive ESRD-related services for home dialysis patients under 2 years old for a full month.
Modifiers may apply depending on the circumstances of service.Consult CPT guidelines and NCCI edits for appropriate modifier usage.
Medical necessity is established by the patient's diagnosis of ESRD, age under 2 years, and the need for comprehensive medical management of their home dialysis care. This includes ongoing monitoring, adjustments, and family support to ensure optimal outcomes.
The physician or other qualified healthcare professional manages all aspects of ESRD care for a home dialysis patient under 2 years old for a full month, including comprehensive evaluation, management, and coordination of care.
- Medicine Services and Procedures > Dialysis Services and Procedures
- 90963-90966 (ESRD services for home dialysis patients)
In simple words: The doctor manages all medical care for a home dialysis patient under 2 years old with kidney failure for a whole month. This includes regular checkups, managing dialysis treatment, monitoring growth, and supporting the family.
This code encompasses all provider services related to the management of a home dialysis patient younger than 2 years of age with end-stage renal disease (ESRD) for an entire month.This includes evaluation and management of all ESRD care, establishing and revising the home dialysis schedule and prescription, monitoring growth and development with intervention for delays, assessing and adjusting nutritional needs, handling telephone and electronic communication, coordinating care, and counseling parents/caregivers and siblings.
Example 1: A 1-year-old with ESRD receives home dialysis. The physician manages their care, adjusts medication, monitors growth, and counsels parents throughout the month. Code 90963 is reported., A 6-month-old ESRD patient on home dialysis requires frequent adjustments to their dialysis regimen due to growth spurts and changing nutritional needs. The physician manages this and provides ongoing support to the family. Code 90963 is reported., A 1.5-year-old child with ESRD on home dialysis experiences an infection requiring adjustments to their care plan.The physician manages this acute complication, monitors for resolution, and continues comprehensive ESRD management, including ongoing family support. Code 90963 is reported.
Detailed medical records demonstrating the comprehensive management of the patient's ESRD, including growth charts, nutritional assessments, dialysis parameters, communication logs with family, and documentation of counseling sessions.
** Medicare considers a month as a calendar month.The first month of dialysis is the date treatments begin to the end of that calendar month.Thereafter, a month refers to each subsequent calendar month.A waiver of the face-to-face visit requirement may be requested from the Medicare contractor on a case-by-case basis.
- Revenue Code: P9A (Dialysis Services)
- RVU: Information not available in provided text.Refer to CMS fee schedules for current RVU values.
- Global Days: This code covers a full calendar month of service.
- Payment Status: Active
- Modifier TC rule: Not applicable.This is a comprehensive code covering all aspects of care.
- Fee Schedule: Information not available in provided text. Refer to CMS fee schedules for historical data.
- Specialties:Nephrology, Pediatric Nephrology
- Place of Service:Home