April 22, 2025, marks the 55th year of Earth Day, a movement that started as a protest against pollution and has grown into a monumental global demand to fight climate change and environmental decline.  

Almost fifteen years ago, the first reports of an unusual form of chronic kidney disease (CKD) emerged from the lowlands of Central America.(1,2) A tiny band of astute internists practicing in rural clinics in Nicaragua and El Salvador noticed over a period of years an epidemic-scale increase in the prevalence of CKD among the agricultural workers in their communities. The condition was both irreversible and progressive in a region poorly able to support the needs of the growing numbers of people with End-Stage Kidney Disease (ESKD).

The 2025 Medicare Physician Fee Schedule (PFS) Final Rule released a new complexity add-on HCPCS code. Although this code has similarities to the G2211 complexity add on code, it has significant restrictions on who can submit claims for its use. The new code, G0545, is a code that is for use by “a physician with specialized training in infectious diseases.”