CPT® Code 90954

Official Description

End-stage renal disease (ESRD) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician or other qualified health care professional per month

Common Language Description

End-stage renal disease (ESRD) related services are specialized medical services provided to children aged 2 to 11 years who are experiencing the severe effects of kidney failure. This CPT® Code 90954 encompasses a comprehensive range of outpatient services delivered over the course of one full month. The primary focus of these services is to monitor the adequacy of nutrition, assess the child's growth and development, and provide counseling to parents or caregivers. The physician or other qualified healthcare professional plays a crucial role in establishing the dialysis regimen, conducting evaluations and management services pertinent to the dialysis process, and overseeing the patient's overall health during the dialysis treatment. This includes regular examinations to identify any existing or potential medical issues, as well as addressing new symptoms or complications as they arise. The healthcare provider ensures that the dialysis services are administered according to the prescribed plan and makes necessary adjustments to the dialysis prescription based on ongoing assessments. This may involve monitoring the patient's weight, advising on dietary and fluid intake, and prescribing specialized renal nutritional supplements when required. Additionally, the healthcare professional reviews laboratory data, monitors medications and nutritional supplements, and implements interventions for any delays in growth or development, which may include the administration of growth hormones. Social development is also a key consideration, with attention given to any behavioral or academic challenges the child may face. Throughout this process, the physician or qualified healthcare professional provides essential support and guidance to parents and caregivers, addressing their questions and concerns. The services captured under this code are billed once per month, contingent upon the provision of four or more face-to-face visits within that timeframe.

1. Indications

The following indications outline the specific circumstances under which CPT® Code 90954 is applicable for patients aged 2 to 11 years:

End-Stage Renal Disease (ESRD) The patient is diagnosed with end-stage renal disease, requiring ongoing management and monitoring of their condition.
Need for Nutritional Monitoring The patient requires assessment of nutritional adequacy to ensure proper dietary management in relation to their renal condition.
Growth and Development Assessment The patient needs regular evaluations to monitor growth and development, which can be affected by ESRD.
Parental Counseling The parents or caregivers require guidance and support regarding the management of the child's condition and any associated challenges.

2. Procedure

The procedure associated with CPT® Code 90954 involves several key steps that are performed throughout the month to ensure comprehensive care for the patient:

Establishment of Dialysis Cycle The physician or qualified healthcare professional establishes the appropriate dialysis cycle tailored to the patient's specific needs, ensuring that the treatment is effective and safe.
Outpatient Evaluation and Management Regular outpatient evaluation and management services are conducted, which include face-to-face visits to assess the patient's health status, monitor for any complications, and adjust treatment plans as necessary.
Routine Examinations The patient undergoes routine examinations to identify any existing medical problems or potential issues that may arise, allowing for timely interventions.
Monitoring of Dialysis Services The healthcare provider ensures that dialysis services are being delivered as prescribed, making adjustments to the dialysis prescription based on the patient's ongoing assessments and needs.
Weight Monitoring and Dietary Recommendations The patient's weight is closely monitored, and dietary recommendations are provided to optimize nutrition and fluid intake, which are critical for managing ESRD.
Laboratory Data Review Laboratory results are reviewed regularly to assess the patient's biochemical status and make informed decisions regarding treatment adjustments.
Medication and Nutritional Supplement Monitoring Medications and nutritional supplements are monitored for efficacy and safety, with changes implemented as needed to support the patient's health.
Interventions for Growth Delays If delays in growth or development are identified, appropriate interventions are initiated, which may include the administration of growth hormones.
Social and Behavioral Monitoring The healthcare provider monitors the patient's social development and addresses any behavioral or school-related issues that may arise.
Parental Counseling Throughout the month, the physician or qualified healthcare professional provides counseling to parents and caregivers, addressing their concerns and questions regarding the child's condition and treatment.

3. Post-Procedure

Post-procedure care for patients receiving services under CPT® Code 90954 includes ongoing monitoring and support. The healthcare provider continues to assess the patient's health status and make necessary adjustments to the treatment plan based on the patient's response to therapy. Follow-up visits are essential to ensure that the patient is progressing appropriately and to address any new symptoms or complications that may arise. Additionally, continued counseling and support for parents and caregivers are vital to help them manage the child's condition effectively and to provide them with the resources they need for ongoing care.

Short Descr	ESRD SERV 4 VSTS P MO 2-11
Medium Descr	ESRD RELATED SVC MONTHLY 2-11 YR OLD 4/> VISITS
Long Descr	End-stage renal disease (ESRD) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician or other qualified health care professional per month
Status Code	Active Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Items and Services Not Billable to the MAC
Type of Service (TOS)	1 - Medical Care
Berenson-Eggers TOS (BETOS)	P9A - Dialysis services (Medicare Fee Schedule)
MUE	1
CCS Clinical Classification	227 - Other diagnostic procedures (interview, evaluation, consultation)

95	Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system.
CR	Catastrophe/disaster related
GW	Service not related to the hospice patient's terminal condition