CPT 90937 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Medicine Services and Procedures • Dialysis Services and Procedures |
| Common Place of Service | • 21 - Inpatient Hospital • 99 - Other POS |
| Common Modifiers | • None • G5 - Most recent URR reading of 75 or greater • V7 - Arteriovenous fistula |
| Complexity Level | Low |
National average reimbursement for CPT 90937 by major payers:
$139.03
$137.75
$136.42
$167.82
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 90937 | ||||||
United | 90937 | $209.41 | 1174859284 - MATTHEW NIEDZWIECKI | 811324691 | RI | Psychiatry Physician (2084P0800X) |
United | 90937 | $95.01 | 1306502703 - RACHEL LABELLA | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Orthopedic Physical Therapist (2251X0800X) |
United | 90937 | $143.75 | 1801813266 - GREGG BEAN | 741586031 | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 90937 | $145.77 | 1225211600 - JOHN MILLICHAP | 841343242 | CO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90937 | $195.13 | 1912385295 - ALYSSA STRAM | 911780160 | NY | Psychiatry Physician (2084P0800X) |
United | 90937 | $233.36 | 1780976399 - ANNA JEONG | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90937 | $137.84 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 90937 | $216.19 | 1417900168 - SUNILA OCONNOR | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90937 | $172.58 | 1780651588 - PATRICIA MUMBY | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 90937 | $219.80 | 1538112859 - FARHA TOKARZ | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90937 | $195.13 | 1760419311 - PETER HEYDEMANN | 911780160 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90937 | $98.11 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 90937 | $125.79 | 1437438249 - KAPIL AEDMA | 430957840 - SWOPE HEALTH SERVICES | MO | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90937 | $183.52 | 1235766916 - AMIRREZA FALLAHI | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | IL | Psychiatry Physician (2084P0800X) |
United | 90937 | $152.33 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 90937 vs. Other Dialysis Services and Procedures Codes
The CPT 90937 code is part of the Medicine Services and Procedures services used for Dialysis Services and Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 90937 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 90935-CPT | Low | Hemodialysis Procedure With Single Evaluation By Physician Or Other Qualified Health Care Professional (Revised 1/1/2013) |
| 90937-CPT | Low | Hemodialysis Procedure Requiring Repeated Evaluation(S) With Or Without Substantial Revision Of Dialysis Prescript |
| 90940-CPT | Low | Hemodial Access Bld Flow Study In Grafts/Fistulae By Indicatr Dilution |
| 90945-CPT | Low | Dialysis Procedure Other Than Hemodialysis (Eg Peritoneal Dialysis Hemofiltration Or Other Continuous Renal Replacement Therapies) With Single Evaluation By A Physician Or Other Qualified Health Care Professional (Revised 1/1/13) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90937. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90937 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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