CPT Codes 90967 and 90970: ESRD Home Dialysis Billing Guide for 2026
Home dialysis billing gets harder when a month does not go as planned. A patient starts treatment mid-month, changes arrangements, or is hospitalized, and the usual monthly code no longer fits. That is where CPT codes 90967 and 90970 come in. This guide explains what they represent, how they differ, and what our billing specialists would verify before a claim goes out.
Quick Answer • 90967 through 90970 are per-day codes for ESRD-related services when home dialysis covers less than a full month. • The family is age-based: 90967 is for patients younger than 2, and 90970 is for patients 20 and older. • Full-month home dialysis uses 90963–90966 instead. • Confirm descriptors in the current CPT code set and rules with your Medicare contractor. |
Understanding CPT Codes 90967 and 90970
CPT reports ESRD-related services for less than a full month of home dialysis per day, with a separate code for each age group. Our reading of the descriptors, which you should confirm against the CPT book, is that 90967 applies to patients younger than 2 and 90970 to patients 20 and older. The codes in between (90968 and 90969) cover ages 2–11 and 12–19. Medicare contractor guidance says the patient’s age at the end of the month determines the age-related code.
Code | Summary | When it may apply | Documentation | Verify |
90967 | Per-day ESRD-related home dialysis services, less than a full month; patient younger than 2 | Partial month of home dialysis for this age group | Days of service, required face-to-face visit, home dialysis records | Age at month end; days reported as units |
90970 | Per-day ESRD-related home dialysis services, less than a full month; patient 20 or older | Partial month of home dialysis for this age group | Same as above | Age at month end; days reported as units |
CPT 90967 vs. CPT 90970: Key Billing Differences
Consideration | CPT 90967 | CPT 90970 |
Patient age | Younger than 2 | 20 and older |
Service basis | Per day, partial month | Per day, partial month |
Interchangeable? | No; age-specific | No; age-specific |
Full-month alternative | 90963 | 90966 |
Key check | Age at end of month | Age at end of month |
Because age at month end drives the choice, one patient would not normally have both codes for the same month. The difference is the age group, not the service. Confirm with your payer.
ESRD Home Dialysis Billing Guidelines for 2026
Step 1: Confirm the patient’s ESRD status and that home dialysis was the arrangement for the dates billed.
Step 2: Decide whether the month was a full month (90963–90966) or partial (90967–90970).
Step 3: Confirm age at month end and select the matching code.
Step 4: Confirm the billing provider completed the assessment and plan of care, and that the required face-to-face visit is documented.
Step 5: Report the days of service as units, not as a count of treatments.
Step 6: Check payer-specific rules and claim edits.
Step 7: Submit after the month ends; contractor guidance says claims billed early are rejected.
These steps mix contractor guidance with our own workflow. Check which parts bind your payer.
How to Handle Partial-Month ESRD Billing
Partial months need extra care because the day count, provider responsibility and facility status all affect the claim. One contractor example describes a patient who received home dialysis for 14 days and was then hospitalized: the age-appropriate code is reported with 14 units. Inpatient dialysis is covered separately under Part A and paid under different rules.
Illustrative Scenario (not an official determination) A patient 20 or older receives home dialysis for part of a month, then changes treatment arrangements. We would verify: the dates of home dialysis, age at month end, the documented face-to-face visit, which provider is responsible, and the payer’s partial-month rules. Only after that would we confirm the code and units. We do not assign a code or payment from these facts alone. |
Documentation Required for Accurate Home Dialysis Claims
Documentation must support the services actually provided and the code submitted. Contractor guidance we reviewed lists home dialysis items such as a signed order, training documentation, the method, frequency and tolerance of sessions, and lab results for the current and prior month. Treat this as a starting list, not a universal rule.
☐ Patient and ESRD information
☐ Signed home dialysis order and training record
☐ Dialysis method, frequency and tolerance
☐ Dates of service and billing period
☐ Provider identity and responsibility
☐ Face-to-face visit by the billing provider
☐ Records of treatment or responsibility changes
☐ Payer-specific requirements
Common CPT 90967 and 90970 Billing Errors
Common error | Why it matters | How to reduce the risk |
Choosing a code without checking age and descriptor | Wrong age group or rejection | Check age at month end |
Wrong service dates | Units may not match days of service | Reconcile dates against records |
Billing a full month as per-day codes, or the reverse | Wrong code family | Decide full vs. partial first |
Confusing per-day billing with MCP rules | Duplicate or conflicting claims | Review monthly rules before submission |
Missing face-to-face visit documentation | Claim may not be supported | Check the record before submitting |
Skipping payer edits | Avoidable rejections | Review edits and policies |
Billing before month end | Contractor guidance says these are rejected | Hold claims until the month closes |
Need Help Reviewing Your Medical Billing Workflow? Our team at MedCloudMD can help your practice evaluate its medical billing and revenue cycle workflows. Contact us to discuss your billing challenges and explore the support that fits your practice. |
A Practical Pre-Submission Billing Checklist
☐ Code validated against the current CPT descriptor
☐ ESRD status and eligibility confirmed
☐ Full vs. partial month decided
☐ Age at month end checked
☐ Service dates and units reconciled
☐ Documentation reviewed
☐ Payer policy and edits checked
☐ No duplicate or conflicting claim
How Better ESRD Billing Workflows Support Revenue Cycle Management
● Reduce preventable coding and documentation errors
● Identify claim issues earlier
● Improve denial follow-up
● Monitor A/R and outstanding claims
● Improve visibility into reimbursement workflows
● Reduce time spent correcting avoidable problems
These steps help, but they do not guarantee payment or eliminate denials.
How MedCloudMD Supports Medical Billing and RCM
We are a medical billing and revenue cycle management company run by a doctor who understands healthcare providers’ challenges. Our team supports claim submission, claims review, denial management, A/R follow-up and workflow reporting. Learn more about MedCloudMD medical billing services. We do not claim ESRD-specific certifications or results.
Frequently Asked Questions
▸ What is CPT 90967 used for?
Per-day ESRD-related home dialysis services for less than a full month, for patients younger than 2.
▸ What is CPT 90970 used for?
The same service for patients 20 and older.
▸ What is the difference between 90967 and 90970?
Patient age group. Both are per-day partial-month codes.
▸ Can 90967 and 90970 be billed for the same patient?
Age at month end determines the code, so both would not normally apply to one patient in one month. Verify with your payer.
▸ How does partial-month billing work?
Report the age-appropriate per-day code with units equal to days of service, and document the required face-to-face visit. Confirm with your contractor.
▸ What documentation supports daily ESRD billing?
Orders, training records, treatment details, dates, provider responsibility and visit notes.
▸ Do Medicare and commercial payers follow the same rules?
Not always. Check each payer’s policy and contract.
▸ How can a practice reduce avoidable errors?
Verify age and dates, review documentation, hold claims until month end and track rejections.
Final Thoughts
Accurate home dialysis billing means choosing the right code, keeping the record aligned with the service, verifying 2026 rules and reviewing claims before submission.
Disclaimer
This article is provided for educational and informational purposes only and does not constitute medical, legal, coding, or reimbursement advice. CPT descriptions, Medicare policies, payer requirements, and reimbursement rules may change. Providers should verify current official guidance, applicable payer policies, and documentation requirements before submitting claims. Coverage and payment depend on the services provided, the patient’s circumstances, and applicable payer rules. MedCloudMD does not guarantee claim approval, reimbursement, or specific financial outcomes.
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