September 17, 2024
We routinely review our coverage, reimbursement, and administrative policies for potential updates. In that review, we take into consideration one or more of the following: evidence-based medicine, professional society recommendations, Centers for Medicare & Medicaid Services (CMS) guidance, industry standards, and our other existing policies.
As a result of a recent review, effective for dates of service on or after September 27, 2024, Current Procedural Terminology (CPT®) codes 90935 and 90937 will be administratively denied when billed in an outpatient setting with an end-stage renal disease (ERSD) diagnosis. These CPT codes are used for inpatient ESRD and non-ESRD procedures, or for outpatient non-ESRD dialysis services.
This update aligns with the national coding and payment standards set by CMS. Additional information is available in the Medicare Claims Processing Manual > Chapter 8 – Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims > Section 170 > Subsection B.
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