CPT 90935: hemodialysis with one physician evaluation
90935 reports one hemodialysis treatment with a single physician evaluation, and Medicare pays it only when the place of service is inpatient hospital. Outpatient dialysis care for a patient with ESRD belongs to the monthly payment instead, billed with a code such as 90960.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026In short: 90935 is the inpatient hemodialysis procedure code for a treatment with one physician evaluation. Medicare pays it only on a claim with an inpatient hospital place of service, and only when the chart shows the physician was present at some point during the treatment. Renal visits on the same date are bundled into it, with narrow exceptions.
What does CPT 90935 report?
90935 reports one hemodialysis treatment in which the physician performs a single evaluation of the patient. Chapter 8, section 170.B, of the Medicare Claims Processing Manual says 90935 and 90937 report hemodialysis for an inpatient with ESRD, and outpatient hemodialysis for a patient without ESRD, such as someone in acute renal failure who needs a short course of dialysis before recovering.
The same section says 90937 is the repeated-evaluation version, and 90945 and 90947 report dialysis other than hemodialysis.
| Item | Value |
|---|---|
| Payment status | A (active, paid under the fee schedule if covered) |
| Global period | 000 |
| Work RVU | 1.44 |
| Total RVU | 1.84 in both settings |
| Non-facility NA indicator | NA (rarely or never performed in the non-facility setting) |
| Practitioner MUE, Q4 2026 | 1 per date, indicator 3, rationale nature of service |
An MAI of 3 is a per-day edit based on clinical benchmarks, according to NCCI Policy Manual Chapter I. Chapter I lets a MAC bypass an MAI 3 edit when evidence supports more units, but section 170.B already bars payment for more than one dialysis service per day.
When is 90935 paid, and when is the work part of the monthly payment?
Medicare pays 90935 only when the claim carries an inpatient hospital place of service. Section 170 says all of a physician's outpatient renal-related services are included in the monthly capitation payment, so the MACs pay the procedure codes only for POS 21, the inpatient hospital code in the CMS place of service set.
A patient admitted only because the outpatient unit had no room is the common trap. Section 160.1 treats that dialysis as outpatient, so the physician's ESRD services fall under the monthly payment.
Presence matters. Section 160.4.B pays on the procedure code only if the physician was physically present with the patient at some time during the dialysis and the medical record documents it, for example in the physician progress note or the nurse's notes.
If the physician sees the patient on a dialysis day but not during the treatment, section 160.4.B says to bill the same hospital visit codes any physician uses for inpatients, such as 99232, and not the procedure code.
Can you bill a visit on the same day as 90935?
Almost never. Section 170.B bundles every renal-related E/M service on the date into 90935. It lists visit families that can be reported with modifier 25 when they are significant and separately identifiable: office and outpatient visits, initial hospital care, discharge day management, consultations and critical care.
Section 160.4.B narrows that list for inpatient dialysis. It says all E/M services on the same day are denied without review, except initial hospital care (99223 and its neighbors), consultations and discharge management (99238), and those may be allowed only if the service is unrelated to ESRD and could not have been furnished during the dialysis.
Chapter 12 adds two controls. Section 30.6.6 says the physician must document that the service was unrelated to the dialysis and could not be performed during it, and section 40.3 says prepayment review applies to 90935, 90937, 90945 and 90947 whenever a visit with modifier 25 is billed with them.
How does 90935 sit on the claim?
Bill it on the CMS-1500 with item 24B set to 21, item 24D showing 90935 and item 24G showing 1, because chapter 26 says the numeral 1 must be entered when one service is performed. Item 24A carries the date of the treatment.
A patient is dialyzed on a Tuesday and the nephrologist documents being at the bedside during the treatment. The claim has one line: POS 21, 90935, 1 unit. There is no visit line, because the same-day renal visit is bundled. A second 90935 line for that date would meet the MUE of 1 and the one-service-per-day rule.
See nephrology billing for the monthly claim and the facility side.
What fields hold a single dialysis session?
A single dialysis evaluation is one line, 90935 in Item 24D with 1 unit in Item 24G and a pointer in Item 24E to the kidney diagnosis. Item 24A holds the date, and Item 24B holds the place of service. RVU26D gives it a 000 global.
On a hospital outpatient bill, the dialysis revenue code goes in FL 42, 90935 in FL 44, the date in FL 45 and units in FL 46. The MUE table allows 1 per date with indicator 3.
Example: A hospitalized patient with acute kidney injury has one session on 10/07. The line is 90935, pointer A (N17.9), 1 unit, $210.00. A second 90935 on the same date needs its own note with the reason.
Why does a 90935 claim deny?
| CARC | What X12 says | What usually causes it |
|---|---|---|
| 97 | The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated | A same-day visit billed with no modifier 25, or an outpatient date that falls under the monthly payment |
| 234 | This procedure is not paid separately | Payer policy treats the dialysis as part of another paid service |
| 18 | Exact duplicate claim/service (use only with group code OA except where state workers' compensation regulations require CO) | Two 90935 lines for one date, or a resubmission |
| 50 | These are non-covered services because this is not deemed a 'medical necessity' by the payer | No note showing presence at the treatment, or a diagnosis that does not support dialysis |
If these denials keep coming back, our denial management team can work them.
Related codes
- Physician Fee Schedule relative value files, RVU26D (October 2026) · CMS
- Medicare NCCI Medically Unlikely Edits, practitioner services table, effective 10-01-2026 · CMS
- Medicare Claims Processing Manual, Chapter 8: Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims · CMS
- Medicare Claims Processing Manual, Chapter 12: Physicians/Nonphysician Practitioners · CMS
- Medicare Claims Processing Manual, Chapter 26: Completing and Processing Form CMS-1500 Data Set · CMS
- 2026 NCCI Medicare Policy Manual, Chapter I: General Correct Coding Policies · CMS
- Place of Service Code Set · CMS
- Claim Adjustment Reason Codes · X12
- Medicare Claims Processing Manual, Chapter 25: Completing and Processing the Form CMS-1450 Data Set · CMS
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Common questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01How do I bill a hemodialysis session?
Bill 90935 on the CMS-1500 with place of service 21 and 1 unit when one physician evaluation was done during an inpatient treatment. Use 90937 when repeated evaluations were needed. The note must show the physician was present at some point during the dialysis.
02Can 90935 be billed for an outpatient dialysis patient?
Not to Medicare for a patient with ESRD. Chapter 8, section 170, says outpatient renal-related physician services are included in the monthly capitation payment, so the MACs pay the procedure code only when the place of service is inpatient hospital. The outpatient work goes on the monthly code.
03Does the physician have to be present for the whole treatment?
The manual requires presence at some time during the course of the dialysis, not for the whole treatment, and the record must document it. If the physician only visits on a dialysis day, the claim uses ordinary hospital visit codes instead of 90935.
04What is the difference between 90935 and 90937?
Both report inpatient hemodialysis. 90935 is for one physician evaluation and 90937 is for repeated evaluations. The October 2026 fee schedule file gives 90937 a higher work RVU of 2.06, against 1.44 for 90935, and both carry an MUE of 1 per date.
05Can I bill a hospital visit on the same day as 90935?
Only if the visit is significant, separately identifiable, unrelated to ESRD and could not have been done during the dialysis. Use modifier 25 and document it. Section 160.4.B denies other same-day E/M services without review, and chapter 12 sends 25 claims with 90935 to prepayment review.
Inpatient dialysis claims denied as bundled?
We check the place of service, presence note and same-day visit lines before a dialysis claim goes out.