CPT code 90945?

Hi Beth,
Can you bill CPT code 90945 for home peritoneal dialysis or is that for a facility only?

If you’re billing for the physician’s services for an adult home dialysis patient (PD or home HD) for a full month, you’d use the CPT code 90966 if the patient is 20 or older. The Medicare reimbursement will be for 2-3 visits per month under the monthly capitation payment. On the Home Dialysis Central website, under Professional Tools, there are Medicare FAQs. One of them has the codes for nephrologist billing. Be sure to scroll the answer to see all the codes.

Thank you for your quick response, Beth. I will look there also but first, can a facility charge cpt code 90945 for at home peritoneal dialysis? It seems to me there is a better code we should be using. Thanks again!

I’ve never personally billed for dialysis. However, a great source of info is the Medicare Claims Processing Manual, Chapter 8. It has all the codes that a dialysis clinic should use to file a claim for all types of outpatient dialysis in Section 50.3.

The Medicare Claims Processing Manual, Chapter 25 describes generically (not specific to ESRD) how to complete the CMS 1450 claim form that is also referred to as the UB-04.

I’d suggest you contact the Medicare Administrative Contractor for your state. Here’s the CMS page with links to a map and list of MACs. Once you find out which MAC covers A/B claims in your state, you can click on the link to get their contact information. Who are the MACs | CMS

Here’s the website forNovitas Solutions (one of the MACs) that provides info about ESRD billing. https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00151907

Great. Thank you for your guidance.