CPT code 90951: ESRD monthly care, under 2 years, 4+ visits2026 Medicare rate & RVUs

Medicare pays $1,183.73 for 90951 nationally in the office and $1,183.73 in a hospital or facility. Local office rates run $1,112.70–$1,583.15.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 90951 covers

CPT 90951 represents a month of ongoing end-stage renal disease management for a child younger than 2 years who receives at least four face-to-face visits from a physician or other qualified health care professional during that month. A nephrologist commonly provides this care in connection with dialysis, assessing matters such as the dialysis plan, fluid status, vascular access, laboratory findings, and related complications. The service is distinct from documenting a single dialysis treatment encounter.

Choose the monthly code using both the patient’s age category and the number of face-to-face visits in the month. The record should support the visits and the ESRD-related assessment and management provided; report the service for the month, not as one unit for each visit. For a patient receiving home dialysis, compare the home-dialysis monthly family, 90963–90966. When management covers only part of a month, compare the age-specific daily service family, 90967–90970.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 90951 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

90951 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 90951 rate is calculated

Each of 90951’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 90951

90951 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

90951 compared with similar codes

How to choose

90952ESRD monthly services2-3 visits, under age 2

Both codes cover monthly ESRD-related management for patients younger than 2 years. Use 90952 for two or three face-to-face visits; 90951 requires at least four.

90953Monthly ESRD servicesOne visit, under age 2

90953 is the one-visit monthly level for a patient younger than 2 years. 90951 requires at least four face-to-face visits during the month.

90963ESRD managementHome dialysis, under age 2

90963 is the monthly code family for home dialysis patients younger than 2 years. 90951 is selected by the four-or-more visit level in the other monthly ESRD service family.

90967ESRD servicesPatient younger than 2

90967 reports age-specific ESRD services by day for a patient younger than 2 years; 90951 represents the monthly service at the four-or-more visit level.

Codes related to 90951

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates