CPT Code 90945: Dialysis procedure other than hemodialysis

Key Takeaways

CPT Code 90945 reports dialysis procedures other than hemodialysis (peritoneal dialysis, hemofiltration, CRRT) with a single physician or QHP evaluation per session

The critical distinction from CPT 90947 is the number of evaluations: one evaluation = 90945, repeated evaluations in the same session = 90947

CPT 90945 bundles the E&M related to the dialysis procedure and renal failure; a separate E&M code may be billed only for a truly unrelated condition

Pabau’s claims management software helps nephrology practices track per-session dialysis codes, modifier usage, and ESRD billing workflows without errors

Nephrology billing carries real financial risk when per-session dialysis codes get confused. A single documentation shortfall on a peritoneal dialysis claim can trigger a denial, a payer audit, or lost revenue that takes months to recover.

CPT Code 90945 is the per-session code for dialysis procedures other than hemodialysis, including peritoneal dialysis, hemofiltration, and continuous renal replacement therapy (CRRT), when a single physician or qualified health care professional (QHP) evaluation is performed. Getting the code right matters from the first claim submission. This reference covers the official description, the 90945 vs. 90947 distinction, documentation requirements, Medicare reimbursement context, and the most common billing errors nephrologists and billers encounter.

CPT Code 90945: definition and clinical description

The official AMA CPT code set defines CPT Code 90945 as: “Dialysis procedure other than hemodialysis (e.g., peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies), with single evaluation by a physician or other qualified health care professional.”

The code falls within the Miscellaneous Dialysis Services and Procedures range (90945-90947) and applies to outpatient, inpatient, and emergency settings. The “other than hemodialysis” framing is intentional: hemodialysis has its own dedicated codes (90935 for single evaluation, 90937 for repeated evaluations). CPT Code 90945 covers the parallel non-hemodialysis modalities.

Modalities covered

• Peritoneal dialysis (PD): Automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) performed in a facility setting
• Hemofiltration: Convective clearance-based renal replacement performed acutely, typically in ICU settings
• Continuous renal replacement therapy (CRRT): Slow continuous modalities (CVVH, CVVHD, CVVHDF) used for critically ill patients with hemodynamic instability
• Other continuous renal replacement therapies: Any additional non-hemodialysis modality where the physician or QHP provides a single evaluation

CPT 90945 vs. CPT 90947: how to choose the right code

The only billing distinction between these two codes is the number of physician or QHP evaluations during the dialysis session.

The evaluation count reflects how many times the physician or QHP assessed the patient during the session, not how many total interactions occurred. A nurse checking vitals between the physician’s single visit does not trigger CPT 90947. The medical record must clearly document when each physician evaluation occurred to support the code selected.

E&M bundling rules for CPT 90945

This is where most denials originate. According to Noridian Medicare (JF Part B MAC), renal dialysis procedure codes 90935, 90937, 90945, and 90947 include E&M services related to the dialysis procedure and the renal failure. You cannot bill a separate E&M code for the dialysis encounter itself.

A separate E&M code is appropriate only when the physician addresses a condition that is genuinely unrelated to dialysis or renal failure during the same visit. The medical record must clearly distinguish the unrelated condition, and Modifier 25 is generally required to signal the separate medically necessary service.

Documentation requirements for CPT Code 90945

Clean documentation protects the claim at every stage, from submission through audit. Per-session dialysis codes like CPT 90945 require the record to support three things: the modality used, the number of physician evaluations, and the clinical findings from that evaluation.

• Modality identification: State that the procedure is peritoneal dialysis, hemofiltration, CRRT, or another non-hemodialysis modality. Do not leave this implied.
• Physician or QHP evaluation note: Document date, time, clinical assessment, and any management decisions made during the evaluation. This distinguishes 90945 (single) from 90947 (repeated).
• ICD-10-CM diagnosis code: N18.6 (End-stage renal disease) is the standard pairing for most ESRD patients. Document the supporting diagnosis in the record.
• Facility vs. professional billing: Facility claims require revenue codes 082X, 083X, or 088X alongside the CPT code to indicate the dialysis modality, per the CMS Medicare Claims Processing Manual (Chapter 8).
• ESRD patient status: Note whether the patient is a managed ESRD patient or an acute renal failure patient, as this affects which code family applies.

Maintaining HIPAA-compliant documentation practices across the nephrology team reduces exposure when payer audits target high-volume dialysis claims. Structured digital intake and clinical forms ensure every required element is captured at the point of care rather than reconstructed from memory afterward.

Medicare reimbursement for CPT 90945

Medicare payment for CPT Code 90945 is set through the Physician Fee Schedule (PFS). Rates vary by geographic locality and are adjusted annually. To find the current rate for your practice location, use the CMS Physician Fee Schedule lookup tool or check current RVU values via the FastRVU 2026 lookup.

A few reimbursement considerations specific to CPT 90945:

• Per-session vs. monthly capitation: CPT 90945 is a per-session code. It is distinct from ESRD monthly capitation codes (90951-90966), which cover comprehensive monthly management for home dialysis and certain outpatient ESRD patients. Use 90945 for individual dialysis sessions not captured under capitation billing.
• HCPCS codes G0491 and G0492: For ESRD patients at home receiving dialysis, CMS uses HCPCS codes G0491 and G0492 for monthly capitation payments rather than 90945. Confirm whether the patient’s care setting and coverage trigger per-session CPT billing or monthly HCPCS capitation before submitting.
• Non-Medicare payers: Commercial payers and Medicaid (such as Medi-Cal) may have different coverage policies and rates. Verify coverage with each payer before assuming Medicare rules apply.
• QHP billing eligibility: Non-physician QHPs (nurse practitioners, physician assistants) may bill CPT 90945 independently, but eligibility varies by payer policy. Confirm each payer’s QHP billing rules.

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Common billing errors with CPT 90945

Dialysis billing is a high-audit area for Medicare. These are the errors that most frequently cause denials or trigger payer scrutiny for CPT Code 90945.

Upcoding to 90947 without documented repeated evaluations

CPT 90947 pays more than 90945, which creates pressure to default to it. Without clear documentation of two or more distinct physician evaluations during the same session, payers will deny the claim or downcode it to 90945 on review. Document evaluation times explicitly.

Billing a separate E&M without Modifier 25 or clinical justification

Submitting a routine E&M code alongside 90945 without Modifier 25 and a clearly documented unrelated condition is a top denial trigger. The dialysis code already includes the E&M for renal failure management. Separate E&M services must meet the “unrelated and separately identifiable” test to survive audit.

Using hemodialysis codes (90935/90937) for peritoneal dialysis

Peritoneal dialysis and CRRT are coded using 90945 or 90947, not 90935 or 90937. Submitting a hemodialysis code for a peritoneal dialysis session is an incorrect code assignment that payers can identify through claims data patterns. Document the modality in the clinical record and match the code accordingly. For broader CPT procedure code resources, including per-session documentation standards, ensure your billing team has a current coding reference.

Missing revenue codes on facility claims

Facility claims submitted without the required revenue code (082X for hemodialysis, 083X for peritoneal dialysis/ESRD, 088X for other dialysis) are incomplete per CMS requirements and will reject. Confirm that your billing team’s workflow includes revenue code assignment for every facility dialysis claim. A claims management workflow that enforces required field completion before submission catches these before they leave the practice.

Related CPT codes for dialysis billing

Nephrology billing requires familiarity with the full dialysis code family to select the right code for each encounter. The table below covers the codes most commonly used alongside or instead of CPT Code 90945.

Verify current code descriptions and coverage rules through AAPC Codify or the CMS fee schedule lookup. Codes and coverage policies update annually. For other per-session coding references, the per-session CPT documentation standards framework applies similarly across specialties. Using nephrology prescription workflows that integrate with billing reduces the risk of modality-code mismatches at submission.

Conclusion

CPT Code 90945 is a precise per-session code: non-hemodialysis modality plus single physician or QHP evaluation. The margin for error is narrow because the distinction from 90947 rests entirely on documentation, and the E&M bundling rules are strict. Practices that standardize their dialysis documentation templates, revenue code workflows, and modifier review processes will have fewer denials and cleaner audit trails.

Pabau’s claims management software helps nephrology practices build those workflows directly into their billing process, from required field validation through submission tracking. To see how it handles dialysis and other specialty billing scenarios, book a demo.

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