CPT 90945
Global 000 ActiveDialysis one evaluation
CPT 90945 Billing & Documentation Guide
CPT code 90945 (Dialysis one evaluation) is classified under Dialysis with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.52, a non-facility practice expense RVU of 0.7, and a malpractice RVU of 0.09, a total non-facility RVU of 2.31 and facility RVU of 2.31. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $78.78, though rates vary from $72.4 to $102.71 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 90945, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 90945 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 90945 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 90945
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.52 | 1.52 |
| Practice Expense RVU | 0.7 | 0.7 |
| Malpractice RVU | 0.09 | 0.09 |
| Total RVU | 2.31 | 2.31 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 90945
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $81.88 | $81.88 | $78.87 - $91.68 | 29 |
| Florida | $80.08 | $80.08 | $77.64 - $82.71 | 3 |
| Georgia | $76.75 | $76.75 | $75.21 - $78.29 | 2 |
| Illinois | $79.28 | $79.28 | $76.81 - $81.52 | 4 |
| Michigan | $76.96 | $76.96 | $75.51 - $78.4 | 2 |
| North Carolina | $74.5 | $74.5 | $74.5 - $74.5 | 1 |
| New York | $83.34 | $83.34 | $75.09 - $87.4 | 5 |
| Ohio | $75.15 | $75.15 | $75.15 - $75.15 | 1 |
| Pennsylvania | $77.34 | $77.34 | $75.07 - $79.61 | 2 |
| Texas | $76.86 | $76.86 | $74.84 - $78.53 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 90945
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 90945 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0216T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0692T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 90945
What does CPT code 90945 mean? +
CPT code 90945 represents: Dialysis one evaluation. It's in the Dialysis category with a global period of 000.
What is the Medicare reimbursement for CPT 90945? +
The 2026 Medicare national average non-facility payment for CPT 90945 is $78.78. Rates range from $72.4 to $102.71 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 90945? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 90945? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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