CPT 90945 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 • GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
National average reimbursement for CPT 90945 by major payers:
$112.69
$106.35
$119.25
$133.75
| 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 90945 | ||||||
United | 90945 | $111.94 | 1942330576 - NASIR SYED | 862358048 - (IL) INSIGHT CHICAGO INC | IL | Psychiatry Physician (2084P0800X) |
United | 90945 | $138.67 | 1740201425 - JOSEPH DIVINCENZO | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | WI | Psychiatry Physician (2084P0800X) |
United | 90945 | $114.38 | 1225211600 - JOHN MILLICHAP | 262037695 - GRADY MEMORIAL HOSPITAL CORPORATION | CO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90945 | $145.03 | 1497080584 - ELIZABETH HOMAN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IA | Psychiatry Physician (2084P0800X) |
United | 90945 | $306.20 | 1225211600 - JOHN MILLICHAP | 800863895 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90945 | $94.30 | 1881647576 - MELISSA CHAPPELL | 363383867 | IL | Psychiatry Physician (2084P0800X) |
United | 90945 | $130.61 | 1790214674 - JENNIFER HARKEY | 363149833 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 90945 | $138.67 | 1326579756 - TONY TU | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 90945 | $111.11 | 1871505230 - MICHAEL NAYLOR | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90945 | $203.41 | 1962791343 - JEREMY WONG | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90945 | $119.95 | 1386969079 - ADAM WALLACE | 363907436 - ROCKFORD HEALTH PHYSICIANS | MN | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90945 | $164.38 | 1740201425 - JOSEPH DIVINCENZO | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 90945 | $125.70 | 1679739395 - BETSY OSTRANDER | 942854057 - IHC HEALTH SERVICES INC | UT | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90945 | $203.41 | 1144203753 - HAIDAR KABBANI | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | OH | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90945 | $98.25 | 1205064011 - LAUREL CLARK | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | IL | Psychiatry Physician (2084P0800X) |
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 90945 vs. Other Dialysis Services and Procedures Codes
The CPT 90945 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 90945 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 | Low | Hemodialysis Procedure With Single Evaluation By Physician Or Other Qualified Health Care Professional (Revised 1/1/2013) |
| 90937 | Low | Hemodialysis Procedure Requiring Repeated Evaluation(S) With Or Without Substantial Revision Of Dialysis Prescript |
| 90940 | Low | Hemodial Access Bld Flow Study In Grafts/Fistulae By Indicatr Dilution |
| 90945 | 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 90945. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90945 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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