CPT code 90954: ESRD management, age 2–11, four visits2026 Medicare rate & RVUs

Medicare pays $1,034.43 for 90954 nationally in the office and $1,034.43 in a hospital or facility. Local office rates run $971.76–$1,382.26.

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

What 90954 covers

This code represents a month of physician management for a patient with end-stage renal disease who is 2 through 11 years old and receives four or more face-to-face visits that month. A nephrologist or other physician managing the child’s renal disease typically provides these services in connection with ongoing dialysis care. The work may involve assessing the child’s condition, reviewing clinical information, and managing the renal treatment plan across the month.

Select this code using the patient’s age and the documented number of face-to-face visits in the month. The record should support the ESRD-related management and the visits counted, rather than treating each dialysis session as a separate monthly service. Report the monthly service that matches the documented visit count and age; codes 90955 and 90956 distinguish lower visit counts for the same age group. CMS assigns physician fee schedule work, practice expense, and malpractice RVUs to this service.

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 90954 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

90954 rates by state

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

How the 90954 rate is calculated

Each of 90954’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 90954

90954 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.

90954 compared with similar codes

How to choose

90955Monthly ESRD careAges 2–11, 2–3 visits

Both cover monthly ESRD management for ages 2–11, but 90955 is for two or three face-to-face visits; 90954 is for four or more.

90956ESRD serviceAges 2–11, one monthly visit

90956 represents one face-to-face visit during the month for ages 2–11. Use 90954 when four or more visits are documented.

90957ESRD monthly careAge 12–19, four or more visits

The visit threshold is the same, but 90957 is for ages 12–19; 90954 is for ages 2–11.

90935HemodialysisOne clinician evaluation

90935 describes a hemodialysis service with a single physician evaluation, rather than monthly ESRD management selected by age and monthly visit count.

Codes related to 90954

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