How To Use CPT Code 90954

CPT 90954 describes the monthly end-stage renal disease (ESRD) related services provided to patients between the ages of 2 and 11 years. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 90954?

CPT 90954 can be used to describe the monthly management of end-stage renal disease (ESRD) related services for patients between the ages of 2 and 11 years. This code is used when a physician or other qualified healthcare professional has at least four face-to-face visits with the patient during the month to provide comprehensive care, including monitoring nutrition adequacy, assessing growth and development, and counseling parents.

2. Official Description

The official description of CPT code 90954 is: ‘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.’

3. Procedure

1. The physician or qualified healthcare professional manages all outpatient ESRD related services for a one-month period for patients between the ages of 2 and 11 years.
2. During this period, the provider has at least four face-to-face visits with the patient to provide comprehensive care.
3. The care includes scheduled and episodic examinations for disease management, establishment and changes to the patient’s dialysis schedule and prescription, oversight of each dialysis visit, review of laboratory tests and medications, monitoring growth and development, assessing nutrition requirements, school progress monitoring, and regular counseling and support for parents and caregivers.
4. The provider coordinates care and communicates with the patient and their family through telephone and electronic means as necessary.

4. Qualifying circumstances

CPT 90954 is applicable to patients between the ages of 2 and 11 years who have end-stage renal disease (ESRD). The provider must have at least four face-to-face visits with the patient during the month to monitor nutrition adequacy, assess growth and development, and provide counseling to parents. The code does not include dialysis treatment.

5. When to use CPT code 90954

CPT code 90954 should be used when a physician or qualified healthcare professional has at least four face-to-face visits with a patient between the ages of 2 and 11 years to provide monthly end-stage renal disease (ESRD) related services. This code should not be reported for patients outside the specified age range or if there are fewer than four face-to-face visits during the month.

6. Documentation requirements

To support a claim for CPT 90954, the provider must document the following information:

• Diagnosis of end-stage renal disease (ESRD)
• Number of face-to-face visits during the month
• Details of the services provided during each visit, including nutrition monitoring, growth and development assessment, and counseling of parents
• Review of laboratory tests, medications, and supplement needs
• Progress and interventions related to growth and development
• Assessment of nutrition requirements and adjustments made
• School progress monitoring, if applicable
• Telephone and electronic communications regarding the patient
• Care coordination and counseling/support provided to parents and caregivers

7. Billing guidelines

When billing for CPT 90954, ensure that the provider has had at least four face-to-face visits with the patient during the month. This code should not be reported for patients outside the specified age range or if there are fewer than four visits. It is important to note that CPT 90954 does not include dialysis treatment, which should be reported separately.

8. Historical information

CPT 90954 was added to the Current Procedural Terminology system on January 1, 2009. There have been no updates or changes to the code since its addition.

9. Examples

1. A physician has at least four face-to-face visits with a 6-year-old patient with end-stage renal disease (ESRD) during a month. The visits include monitoring nutrition adequacy, assessing growth and development, and counseling the parents.
2. A qualified healthcare professional sees a 9-year-old patient with ESRD four times during a month to provide comprehensive care, including nutrition monitoring, growth and development assessment, and counseling of parents.
3. A physician has four face-to-face visits with an 11-year-old patient with ESRD to monitor nutrition, assess growth and development, and provide counseling to parents.