2025 CPT code 90969
(Active) Effective Date: N/A Revision Date: N/A Medicine Services and Procedures - Dialysis Services and Procedures Medicine Feed
End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients 12-19 years of age.
Modifiers may apply depending on the circumstances of service. Consult the appropriate modifier guidelines.
Medical necessity is established by the patient's diagnosis of ESRD and the need for daily management of the condition. Documentation should support the reason for less than a full month of service.
The physician or qualified healthcare professional is responsible for managing all daily outpatient ESRD-related services for a dialysis patient aged 12-19 years for less than a full month.This includes assessment, evaluation, management, telephone calls, and patient management during dialysis.Inpatient services are reported separately.
In simple words: This code is used when a doctor manages the daily care of a dialysis patient (aged 12-19) with kidney failure for less than a full month. The doctor bills for each day of service. This applies to patients who are new to dialysis, have a partial month of service, or change doctors mid-month.
This CPT code reports end-stage renal disease (ESRD)-related services for dialysis for patients aged 12-19 years when services are provided for less than a full month.It is billed per day and applies to various scenarios, including partial months with one or more face-to-face visits but without a complete assessment, transient patients, hospitalizations preceding a complete assessment, dialysis cessation due to recovery or death, or a patient changing providers mid-month. Each day of service is reported separately.
Example 1: A 16-year-old patient with ESRD starts home dialysis on July 15th and is hospitalized on July 22nd.Code 90969 is reported for July 15th-21st. Inpatient services are reported separately., A 14-year-old patient receives dialysis for a partial month due to a kidney transplant. Code 90969 is used for each day of service prior to the transplant., A 17-year-old patient's dialysis is stopped due to unforeseen circumstances and he needs only 10 days of service for this month. 90969 would be used for each of these 10 days.
Medical record must show a detailed record of daily ESRD-related services provided to a patient aged 12-19 years,including the number of face-to-face visits, patient assessment,and any other services provided.Hospitalization records (if applicable) should be included.
** This code is for ESRD-related services for less than a full month; any other services provided to the patient should be billed separately.
- Revenue Code: 0821, 0841, 0851 (depending on dialysis type)
- RVU: The RVUs for this code vary based on the geographic location and payer. Consult the appropriate fee schedule for the specific RVU value.
- Global Days: This code is billed per day, not within a global period.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Historical fee schedule data is not provided. Consult the appropriate fee schedule for the relevant period.
- Specialties:Nephrology
- Place of Service:Office, Home, Inpatient Hospital, Outpatient Hospital