2025 CPT code 90968
(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
Provides daily ESRD-related services for dialysis patients aged 2-11 years for less than a full month.
Modifiers may apply depending on the circumstances. Consult the latest CPT guidelines and payer-specific instructions.
Medical necessity is established by documentation supporting the need for dialysis and the reasons for less than a full month of service.
Managing all daily outpatient ESRD-related services for a child (2-11 years) receiving dialysis for less than a month.
In simple words: This code covers the doctor's daily care for a child (ages 2-11) with kidney failure who needs dialysis but only for part of a month.This might be because the child is in the hospital, moves, has a transplant, or stops dialysis for a while.
This CPT code reports the comprehensive management of daily outpatient ESRD-related services for a dialysis patient aged 2 to 11 years who receives dialysis for less than a full month.It's reported per day for situations such as partial-month home dialysis, transient patients, patients with one or more face-to-face visits without a complete assessment (including hospitalization before assessment, dialysis cessation due to death or recovery, or kidney transplant), or a provider change mid-month.
Example 1: A 6-year-old with ESRD starts home dialysis on July 15th. Dialysis ceases on July 22nd due to a kidney transplant. Code 90968 is reported for each day from July 15th-22nd., A 10-year-old ESRD patient is hospitalized from August 5th-12th and receives outpatient dialysis before and after hospitalization during August.Appropriate inpatient E/M codes are billed for the hospitalization, and 90968 is reported for each day of outpatient dialysis before and after hospitalization., An 8-year-old with ESRD requires dialysis for only the first two weeks of September.Code 90968 is billed for each of those 14 days.
Comprehensive medical records documenting the patient's diagnosis, dates of dialysis, number of face-to-face visits, reasons for less than a full month of service (e.g., hospitalization, transplant, death), and any other relevant clinical information.
** This code is specific to patients aged 2-11 years old with ESRD.For other age groups, refer to other codes in the 90967-90970 range. Inpatient dialysis services are coded separately.
- Revenue Code: P9A (Dialysis Services)
- RVU: The RVUs are not explicitly defined here.Consult the current Medicare Physician Fee Schedule for the most up-to-date values.
- Global Days: This code is reported per day, not within a global period.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Fee schedules vary by payer and year. Refer to historical Medicare Physician Fee Schedules for past payment amounts.
- Specialties:Nephrology, Pediatric Nephrology
- Place of Service:Office, Home, other Outpatient settings