Physician Self-Dialysis Training Services

CPT Codes Descriptor

• 90989 — Dialysis training, completed course
• 90993 — Dialysis training, course not completed (per session)

CPT code 90989 — Completed Course

• A completed course is considered to be 25 training sessions
• The date of service must be the date that training was completed
• The days/units must be “1”
• This code should not be submitted until the course has been completed
• The allowed dollar amount is a flat fee, subject to deductible and co-insurance requirements

CPT code 90993 — Course Not Completed

• Use this code when the training course was not completed
• The date(s) of service must be the date(s) each training session occurred
• The days/units must be the number of training dates
• The allowed dollar amount is a prorated amount of the complete course amount, subject to deductible and co-insurance requirements
  • For example, if the 25 session completed course (CPT 90989) flat fee is $500, the “per session” amount would be $20 ($500 divided by 25=$20). If 15 sessions were performed, the allowed dollar amount would be $300 ($20x15).

CPT code 90993 – Subsequent Training After Completed Course

• Sometimes it is necessary to furnish additional training after the initial training course is completed
• The amount of additional training required depends upon the transferability of the skills the patient has already learned
• Subsequent training would normally be very limited and should not be billed for ongoing services that would be considered part of the original training; for example, answering the patient’s questions in regards to the machine the patient has already been trained to use
• Documentation must be submitted with the claim indicating the reason why retraining was necessary. Acceptable reasons are:
  • Change in equipment (to a machine the patient was not previously trained to use)
  • Change in the type of dialysis (e.g., hemodialysis to peritoneal dialysis)
  • Change in the setting or dialysis partner

Reference: CMS Claim Processing Manual 100-04, Chapter 8, Section 150 (PDF, 1.86 MB).