2025 CPT code 90965
(Active) Effective Date: N/A Medicine - Dialysis Services and Procedures Feed
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 and development, and counseling of parents.
Modifiers may be applicable to this code in certain circumstances, such as reduced services (modifier 52) or discontinued procedures (modifier 53).
Medical necessity for this code is established by the patient's diagnosis of ESRD and the need for ongoing management of their home dialysis treatment. Documentation should support the medical necessity of the services provided.
The provider manages all ESRD-related physician services for a one-month period for a patient receiving home dialysis care and between 12 and 19 years old. This includes establishing and revising the home dialysis schedule and prescription, monitoring growth and development, assessing nutritional needs, monitoring pubertal development and school performance, and providing counseling and support to parents/caregivers and siblings.
In simple words: The doctor manages all the medical services for one full month for the home dialysis care of a teenager (12-19 years old) with end-stage kidney disease (ESRD). This includes checking their nutrition, how they're growing, and providing support to their parents.
The provider manages all the physician-related services for one full month for the home dialysis care of a patient who is 12 to 19 years old and has a condition known as end-stage renal disease, or ESRD.The care bundled into this code includes the evaluation and management of all the patient’s ESRD care and such services as the establishment of and revisions to the patient’s home dialysis schedule and prescription; monitoring the patient’s growth and developmental progress; ongoing assessment of nutrition requirements and adjustments as necessary; monitoring of pubertal development and school progress with initiation of related intervention with counseling of parents; telephone and electronic communications regarding the patient; care coordination; regular counseling and support of the parents and/or caregivers and siblings; and planning and assessment of progress for future transition to adult care.
Example 1: A 15-year-old patient receiving home dialysis requires monthly monitoring of their ESRD, including adjustments to their dialysis prescription and nutritional assessment., A 13-year-old patient starting home dialysis needs an initial assessment, establishment of a dialysis schedule, and parent counseling., A 17-year-old patient with ESRD on home dialysis requires ongoing care coordination, including communication with the nephrologist and other healthcare providers.
Documentation should include the patient's age, diagnosis of ESRD, type of home dialysis, details of the services provided (e.g., monitoring, assessment, counseling), and any changes to the treatment plan.
- Revenue Code: P9A - DIALYSIS SERVICES (MEDICARE FEE SCHEDULE)
- Global Days: This code represents a full month (30 days) of service.
- Payment Status: Active
- Specialties:Nephrology
- Place of Service:Home