CPT® Code 90955

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 2-3 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 advanced stages of kidney failure. This CPT® code 90955 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 related to the dialysis process, and ensuring that the patient receives appropriate oversight throughout the month. This includes routine examinations to identify any existing or potential medical issues, as well as addressing new symptoms or problems as they arise. The healthcare provider is responsible for ensuring that dialysis services are administered according to the prescribed plan, making necessary adjustments to the dialysis prescription, and monitoring the patient's weight, dietary intake, and fluid consumption. Additionally, the provider may prescribe special renal nutritional supplements when required. Regular review of laboratory data is also a critical component of these services, allowing for the monitoring of medications and nutritional supplements, with adjustments made as necessary. Interventions may be initiated to address any delays in growth or development, which could include the administration of growth hormone injections. Furthermore, the healthcare professional monitors the child's social development and addresses any behavioral or academic challenges. Throughout this process, the physician or qualified healthcare professional provides essential counseling to parents and caregivers, addressing their questions and concerns. The services captured under this code are billed once per month, reflecting the number of face-to-face visits conducted, which can range from two to three visits in total.

1. Indications

The following indications are explicitly provided for the use of CPT® code 90955:

End-stage renal disease (ESRD) Services are specifically for children aged 2 to 11 years who are diagnosed with ESRD.
Monitoring of nutrition Adequacy of nutrition must be assessed to ensure the child is receiving appropriate dietary support.
Assessment of growth and development Regular evaluations are necessary to monitor the child's physical growth and developmental milestones.
Counseling of parents Parents or caregivers require guidance and support regarding the management of the child's condition.

2. Procedure

The procedure for CPT® code 90955 involves several key steps that are performed throughout the month:

Establishment of the dialysis regimen The physician or qualified healthcare professional establishes the appropriate dialysis cycle tailored to the individual needs of the patient, ensuring that the treatment is effective and safe.
Outpatient evaluation and management The healthcare provider conducts regular outpatient evaluations to assess the patient's health status, addressing any existing medical problems and monitoring for potential complications related to ESRD.
Routine examinations The patient is examined on a routine basis to identify any new symptoms or issues that may arise, allowing for timely intervention and management.
Monitoring of dialysis services The physician ensures that dialysis services are being delivered as prescribed, making necessary adjustments to the dialysis prescription based on the patient's response and needs.
Weight and dietary monitoring The patient's weight is closely monitored, and recommendations regarding diet and fluid intake are provided to optimize health outcomes.
Prescription of renal supplements If needed, the healthcare provider prescribes special renal nutritional supplements to support the patient's dietary requirements.
Review of laboratory data Laboratory results are reviewed regularly to assess the patient's biochemical status and to guide treatment decisions.
Medication and supplement management The healthcare provider monitors the patient's medications and nutritional supplements, making adjustments as necessary to ensure optimal care.
Interventions for growth delays If there are delays in growth or development, appropriate interventions are initiated, which may include the administration of growth hormones.
Social and behavioral monitoring The healthcare provider monitors the child's social development and addresses any behavioral or academic issues that may arise.
Parent and caregiver 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 care.

3. Post-Procedure

Post-procedure care for patients receiving services under CPT® code 90955 includes ongoing monitoring and support. The healthcare provider continues to assess the child's health status and growth, ensuring that any new symptoms or issues are promptly addressed. Regular follow-up visits are essential to maintain the effectiveness of the dialysis regimen and to make any necessary adjustments. Parents and caregivers are encouraged to maintain open communication with the healthcare team, reporting any changes in the child's condition or concerns that may arise. The overall goal of post-procedure care is to ensure the child's well-being and to support their growth and development while managing the complexities of end-stage renal disease.

Short Descr	ESRD SRV 2-3 VSTS P MO 2-11
Medium Descr	ESRD RELATED SVC MONTHLY 2-11 YR OLD 2/3 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 2-3 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)