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Dialysis Services (In/Outpatient) Same Date as an Evaluation & Management Service
- CPT codes 90935 and 90937 are used to report inpatient ESRD hemodialysis and outpatient hemodialysis performed on non-ESRD patients (e.g., patients in acute renal failure requiring a brief period of dialysis prior to recovery)
- CPT codes 90945 and 90947 are used to report all non-hemodialysis procedures
- All four of these codes include payment for any evaluation and management (E/M) services related to the patient's renal disease that are provided on the same date as the dialysis service
- Therefore, payment for all E/M services is bundled into the payment for CPT codes 90935, 90937, 90945 and 90947, except for the following E/M services which may be reported on the same date as a dialysis service if they are 'significant and separately identifiable' and meet any medical necessity requirements:
| CPT Codes | Description |
| 99201-99205 |
Office or Other Outpatient Visit for a New Patient |
| 99211-99215 |
Office or Other Outpatient Visit for an Established Patient |
| 99221-99223 |
Initial Hospital Care for a New or Established Patient |
| 99238-99239 |
Hospital Discharge Day Management Services |
| 99241-99245 |
Office or Other Outpatient Consultations, New or Established |
| 99251-99255 |
Initial Inpatient Consultations, New or Established Patient |
| 99291-99292 |
Critical Care Services |
In the absence of one of these codes being reported with CPT modifier 25 and meeting the medical necessity requirements, only the dialysis service will be considered for coverage. Furthermore, payment is not allowed for more than one dialysis service per day.
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