CPT Code 90960 is used to report for billing procedures of end-stage renal disease (ESRD) related services. To be eligible for CPT 90960, patients must meet the following criteria:
- They must have ESRD.
- They must be 20 years of age or older.
- They must have 4 or more face-to-face visits with a physician or other qualified healthcare professional per month.
ESRD is a chronic condition in which the kidneys fail to function properly. Patients with this disease require dialysis or a kidney transplant to survive.
What services are covered by CPT code 90960?
It covers a wide range of ESRD-related services, including:
- Medical evaluations and assessments
- Management of ESRD complications, such as anemia, fluid overload, and hypertension
- Counseling on diet, exercise, and lifestyle changes
- Coordination of care with other healthcare professionals
- Education on ESRD and self-management
How is CPT Code 90960 billed?
It is billed on a monthly basis, regardless of the number of services provided. This is a bundled code, which means that it includes all of the ESRD-related services that are typically provided to patients in a given month.
What is the documentation requirement for CPT Code 90960?
To support a claim for code 90960, the following documentation must be submitted:
- A diagnosis of ESRD.
- Documentation of all face-to-face visits with a physician or other qualified health care professional during the month.
- Documentation of all ESRD-related services provided during the month.
CPT 90960 reimbursement
In 2021, the national median payment for CPT 90960 has risen from $291 to $337. This payment covers monthly services for ESRD patients, with the managing physician overseeing all care. The monthly amount paid is the same for all dialysis locations. The proposed rule includes CPT codes 90960-90970, with MCP receiving 13-29% increases.