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End-stage renal disease (ESRD) related services encompass a comprehensive range of medical care provided to patients undergoing home dialysis. Specifically, CPT® Code 90964 pertains to these services for pediatric patients aged 2 to 11 years. The primary focus of this code is to ensure that the patient receives adequate support and monitoring throughout the dialysis process over a full month. This includes a thorough evaluation of the patient's nutritional needs, growth, and developmental milestones, which are critical during this formative age. The physician plays a vital role in establishing the dialysis regimen, conducting regular outpatient evaluations, and managing any complications or new symptoms that may arise. Additionally, the physician is responsible for overseeing the home dialysis process, ensuring that it is conducted according to the prescribed plan, and making necessary adjustments to optimize the patient's health outcomes. This code also emphasizes the importance of parental involvement, as counseling and support for parents and caregivers are integral components of the care provided. Overall, CPT® Code 90964 captures the multifaceted approach required to manage the complex needs of young patients with ESRD receiving home dialysis.
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The following indications are explicitly associated with the use of CPT® Code 90964 for end-stage renal disease (ESRD) related services:
The procedural steps associated with CPT® Code 90964 are as follows:
Post-procedure care for patients receiving ESRD-related services under CPT® Code 90964 includes ongoing monitoring of the patient's health status and regular follow-up appointments to assess the effectiveness of the home dialysis regimen. The physician continues to provide support and guidance to parents and caregivers, ensuring they are equipped to manage the child's care at home. Any necessary adjustments to the treatment plan are made based on the patient's progress, and additional referrals to specialists may be initiated if new health concerns arise. The overall goal is to maintain the patient's health and well-being while providing comprehensive support to the family throughout the treatment process.
| Short Descr | ESRD HOME PT SERV P MO 2-11 | Medium Descr | ESRD SVC HOME DIALYSIS FULL MONTH 2-11 YR OLD | Long Descr | End-stage renal disease (ESRD) related services for home dialysis per full month, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents | 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) |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | 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 | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider |
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| 2011-01-01 | Changed | Short description changed. |
| 2009-01-01 | Added | - |
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