CPT code 90954: ESRD management, age 2–11, four visits2026 Medicare rate & RVUs in North Carolina
Monthly ESRD management for a child age 2 through 11 when four or more face-to-face visits are documented during the month.
In North Carolina, Medicare pays $998.94 for 90954 in the office and $998.94 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 90954 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
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.
How North Carolina compares for 90954
Across 109 of 109 payment localities, the office rate for 90954 runs from $971.76 in Arkansas to $1,382.26 in Alaska. North Carolina pays $998.94. The RVUs are the same everywhere; the geographic indexes change the dollars.
- North Carolina · this page$998.94
- Los Angeles, CA · California$1,102.08+$103.14
- Washington, DC area · District of Columbia$1,129.31+$130.37
- Miami, FL · Florida$1,113.38+$114.44
- Chicago, IL · Illinois$1,097.44+$98.50
- Manhattan, NY · New York$1,152.27+$153.33
- Alaska · Alaska$1,382.26+$383.32
Other areas in North Carolina first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $978.70 | $978.70 |
| ArkansasArkansas | $971.76 | $971.76 |
| ArizonaArizona | $1,019.01 | $1,019.01 |
| Bakersfield, CACalifornia | $1,058.77 | $1,058.77 |
| Chico, CACalifornia | $1,054.19 | $1,054.19 |
| El Centro, CACalifornia | $1,054.40 | $1,054.40 |
| Fresno, CACalifornia | $1,054.19 | $1,054.19 |
| Hanford, CACalifornia | $1,054.19 | $1,054.19 |
| Madera, CACalifornia | $1,054.19 | $1,054.19 |
| Merced, CACalifornia | $1,054.19 | $1,054.19 |
| Modesto, CACalifornia | $1,054.19 | $1,054.19 |
| Napa, CACalifornia | $1,150.26 | $1,150.26 |
| Oxnard, CACalifornia | $1,090.93 | $1,090.93 |
| Redding, CACalifornia | $1,054.19 | $1,054.19 |
| Rest of CaliforniaCalifornia | $1,054.19 | $1,054.19 |
| Riverside, CACalifornia | $1,068.75 | $1,068.75 |
| Sacramento, CACalifornia | $1,087.12 | $1,087.12 |
| Salinas, CACalifornia | $1,082.46 | $1,082.46 |
| San Diego, CACalifornia | $1,092.90 | $1,092.90 |
| Marin County, CACalifornia | $1,197.46 | $1,197.46 |
| San Francisco, CACalifornia | $1,195.97 | $1,195.97 |
| San Benito County, CACalifornia | $1,220.68 | $1,220.68 |
| Santa Clara County, CACalifornia | $1,214.60 | $1,214.60 |
| San Luis Obispo, CACalifornia | $1,066.82 | $1,066.82 |
| Santa Cruz, CACalifornia | $1,091.95 | $1,091.95 |
| Santa Maria, CACalifornia | $1,082.42 | $1,082.42 |
| Santa Rosa, CACalifornia | $1,102.04 | $1,102.04 |
| Stockton, CACalifornia | $1,054.19 | $1,054.19 |
| Vallejo, CACalifornia | $1,148.12 | $1,148.12 |
| Visalia, CACalifornia | $1,054.19 | $1,054.19 |
| Yuba City, CACalifornia | $1,054.19 | $1,054.19 |
| ColoradoColorado | $1,052.02 | $1,052.02 |
| ConnecticutConnecticut | $1,080.18 | $1,080.18 |
| DelawareDelaware | $1,029.96 | $1,029.96 |
| Fort Lauderdale, FLFlorida | $1,073.60 | $1,073.60 |
| Rest of FloridaFlorida | $1,043.50 | $1,043.50 |
| Atlanta, GAGeorgia | $1,050.01 | $1,050.01 |
| Rest of GeorgiaGeorgia | $1,011.08 | $1,011.08 |
| Hawaii, Guam, HIHawaii | $1,056.27 | $1,056.27 |
| IowaIowa | $983.06 | $983.06 |
| IdahoIdaho | $987.85 | $987.85 |
| East St. Louis, ILIllinois | $1,055.28 | $1,055.28 |
| Rest of IllinoisIllinois | $1,033.49 | $1,033.49 |
| Suburban Chicago, ILIllinois | $1,081.02 | $1,081.02 |
| IndianaIndiana | $990.48 | $990.48 |
| KansasKansas | $984.51 | $984.51 |
| KentuckyKentucky | $998.08 | $998.08 |
| New Orleans, LALouisiana | $1,023.03 | $1,023.03 |
| Rest of LouisianaLouisiana | $998.79 | $998.79 |
| Metropolitan Boston, MAMassachusetts | $1,115.20 | $1,115.20 |
| Rest of MassachusettsMassachusetts | $1,052.27 | $1,052.27 |
| Baltimore area, MDMaryland | $1,077.40 | $1,077.40 |
| Rest of MarylandMaryland | $1,041.33 | $1,041.33 |
| Rest of MaineMaine | $994.37 | $994.37 |
| Southern Maine, MEMaine | $1,015.63 | $1,015.63 |
| Detroit, MIMichigan | $1,054.15 | $1,054.15 |
| Rest of MichiganMichigan | $1,014.50 | $1,014.50 |
| MinnesotaMinnesota | $1,012.15 | $1,012.15 |
| Metropolitan Kansas City, MOMissouri | $1,015.49 | $1,015.49 |
| Metropolitan St. Louis, MOMissouri | $1,020.40 | $1,020.40 |
| Rest of MissouriMissouri | $992.73 | $992.73 |
| MississippiMississippi | $982.15 | $982.15 |
| MontanaMontana | $1,034.34 | $1,034.34 |
| North DakotaNorth Dakota | $1,008.44 | $1,008.44 |
| NebraskaNebraska | $984.58 | $984.58 |
| New HampshireNew Hampshire | $1,041.01 | $1,041.01 |
| Northern New JerseyNew Jersey | $1,128.32 | $1,128.32 |
| Rest of New JerseyNew Jersey | $1,093.58 | $1,093.58 |
| New MexicoNew Mexico | $1,018.82 | $1,018.82 |
| NevadaNevada | $1,027.41 | $1,027.41 |
| NYC suburbs and Long Island, NYNew York | $1,172.07 | $1,172.07 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $1,102.89 | $1,102.89 |
| Queens, NYNew York | $1,151.85 | $1,151.85 |
| Rest of New YorkNew York | $1,006.73 | $1,006.73 |
| OhioOhio | $1,009.20 | $1,009.20 |
| OklahomaOklahoma | $993.22 | $993.22 |
| Portland, OROregon | $1,067.00 | $1,067.00 |
| Rest of OregonOregon | $1,020.25 | $1,020.25 |
| Metropolitan Philadelphia, PAPennsylvania | $1,067.46 | $1,067.46 |
| Rest of PennsylvaniaPennsylvania | $1,007.92 | $1,007.92 |
| Puerto RicoPuerto Rico | $1,037.00 | $1,037.00 |
| Rhode IslandRhode Island | $1,052.64 | $1,052.64 |
| South CarolinaSouth Carolina | $1,005.52 | $1,005.52 |
| South DakotaSouth Dakota | $1,005.37 | $1,005.37 |
| TennesseeTennessee | $987.42 | $987.42 |
| Austin, TXTexas | $1,047.88 | $1,047.88 |
| Beaumont, TXTexas | $1,004.87 | $1,004.87 |
| Brazoria, TXTexas | $1,027.73 | $1,027.73 |
| Dallas, TXTexas | $1,033.31 | $1,033.31 |
| Fort Worth, TXTexas | $1,030.94 | $1,030.94 |
| Galveston, TXTexas | $1,030.42 | $1,030.42 |
| Houston, TXTexas | $1,054.39 | $1,054.39 |
| Rest of TexasTexas | $1,015.19 | $1,015.19 |
| UtahUtah | $1,012.33 | $1,012.33 |
| VirginiaVirginia | $1,016.57 | $1,016.57 |
| Virgin Islands, VIUnited States Virgin Islands | $1,037.00 | $1,037.00 |
| VermontVermont | $1,009.87 | $1,009.87 |
| Rest of WashingtonWashington | $1,048.60 | $1,048.60 |
| King County, WAWashington | $1,127.98 | $1,127.98 |
| WisconsinWisconsin | $991.80 | $991.80 |
| West VirginiaWest Virginia | $1,014.78 | $1,014.78 |
| WyomingWyoming | $1,023.05 | $1,023.05 |
90954 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$971.76
$1,382.26
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $1,382.26 | 1 |
| AL | $978.70 | 1 |
| AR | $971.76 | 1 |
| AZ | $1,019.01 | 1 |
| CA | $1,054.19–$1,220.68 | 29 |
| CO | $1,052.02 | 1 |
| CT | $1,080.18 | 1 |
| DC | $1,129.31 | 1 |
| DE | $1,029.96 | 1 |
| FL | $1,043.50–$1,113.38 | 3 |
| GA | $1,011.08–$1,050.01 | 2 |
| GU | $1,056.27 | 1 |
| HI | $1,056.27 | 1 |
| IA | $983.06 | 1 |
| ID | $987.85 | 1 |
| IL | $1,033.49–$1,097.44 | 4 |
| IN | $990.48 | 1 |
| KS | $984.51 | 1 |
| KY | $998.08 | 1 |
| LA | $998.79–$1,023.03 | 2 |
| MA | $1,052.27–$1,115.20 | 2 |
| MD | $1,041.33–$1,129.31 | 3 |
| ME | $994.37–$1,015.63 | 2 |
| MI | $1,014.50–$1,054.15 | 2 |
| MN | $1,012.15 | 1 |
| MO | $992.73–$1,020.40 | 3 |
| MS | $982.15 | 1 |
| MT | $1,034.34 | 1 |
| NC | $998.94 | 1 |
| ND | $1,008.44 | 1 |
| NE | $984.58 | 1 |
| NH | $1,041.01 | 1 |
| NJ | $1,093.58–$1,128.32 | 2 |
| NM | $1,018.82 | 1 |
| NV | $1,027.41 | 1 |
| NY | $1,006.73–$1,172.07 | 5 |
| OH | $1,009.20 | 1 |
| OK | $993.22 | 1 |
| OR | $1,020.25–$1,067.00 | 2 |
| PA | $1,007.92–$1,067.46 | 2 |
| PR | $1,037.00 | 1 |
| RI | $1,052.64 | 1 |
| SC | $1,005.52 | 1 |
| SD | $1,005.37 | 1 |
| TN | $987.42 | 1 |
| TX | $1,004.87–$1,054.39 | 8 |
| UT | $1,012.33 | 1 |
| VA | $1,016.57–$1,129.31 | 2 |
| VI | $1,037.00 | 1 |
| VT | $1,009.87 | 1 |
| WA | $1,048.60–$1,127.98 | 2 |
| WI | $991.80 | 1 |
| WV | $1,014.78 | 1 |
| WY | $1,023.05 | 1 |
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.
How the rate is built · 90954
RVUs × geographic indexes × conversion factor
Work20.86
20.86 RVUs× 1.000 GPCI
Practice expense8.80
8.80 RVUs× 1.000 GPCI
Malpractice1.31
1.31 RVUs× 1.000 GPCI
Adjusted RVUs
30.9700
Conversion factor
$33.4009
Medicare rate
$1,034.43
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact North Carolina inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
11,567
- Code
- 90954
- Physician work
- 20.86
- Practice expense
- 8.80
- Malpractice
- 1.31
GPCI2026.csv
83
- Locality
- North Carolina
- Physician work
- 1.000
- Practice expense
- 0.933
- Malpractice
- 0.639
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 20.86 | × 1.000 | 20.8600 |
| Practice expense | 8.80 | × 0.933 | 8.2104 |
| Malpractice | 1.31 | × 0.639 | 0.8371 |
| Total RVUs | 29.9075 | ||
| Conversion factor | × 33.4009 | ||
Office rate, North Carolina$998.94
Office: (20.86 × 1 + 8.8 × 0.933 + 1.31 × 0.639) × $33.4009 = $998.94
Facility: (20.86 × 1 + 8.8 × 0.933 + 1.31 × 0.639) × $33.4009 = $998.94
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.
Place of service · 90954
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$1,034.43
- Non-facility (office)
- $1,034.43
- Facility
- $1,034.43
Higher because the practice carries its own overhead.
How 90954 has changed in North Carolina
90954 · Office / nonfacility
$998.94
Effective 2026-10-01
The base rate is $67.51 higher than on 2025-10-01, moving from $931.43 to $998.94 (7.2%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$931.43changed to$998.94
- Conversion factor 32.3465 changed to 33.4009
- Practice expense RVU 7.60 changed to 8.80
- Malpractice RVU 1.35 changed to 1.31
- Practice expense GPCI 0.926 changed to 0.933
- Malpractice GPCI 0.665 changed to 0.639
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$957.60changed to$931.43
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 7.57 changed to 7.60
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$941.97changed to$957.60
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$975.99changed to$941.97
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 7.51 changed to 7.57
- Malpractice RVU 1.32 changed to 1.35
- Practice expense GPCI 0.927 changed to 0.926
- Malpractice GPCI 0.742 changed to 0.665
January 1, 2023
RVU23A
$1005.14changed to$975.99
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 7.62 changed to 7.51
- Malpractice RVU 1.36 changed to 1.32
- Practice expense GPCI 0.928 changed to 0.927
- Malpractice GPCI 0.819 changed to 0.742
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$769.44changed to$1005.14
- Conversion factor 34.8931 changed to 34.6062
- Work RVU 15.98 changed to 20.86
- Practice expense RVU 5.66 changed to 7.62
- Malpractice RVU 1.00 changed to 1.36
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$808.49changed to$769.44
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 6.10 changed to 5.66
- Malpractice RVU 0.99 changed to 1.00
- Practice expense GPCI 0.930 changed to 0.928
- Malpractice GPCI 0.757 changed to 0.819
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$802.02changed to$808.49
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 6.03 changed to 6.10
- Malpractice RVU 0.95 changed to 0.99
- Practice expense GPCI 0.931 changed to 0.930
- Malpractice GPCI 0.695 changed to 0.757
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$802.31changed to$802.02
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 6.05 changed to 6.03
- Malpractice RVU 0.97 changed to 0.95
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$801.39changed to$802.31
- Conversion factor 35.8887 changed to 35.9996
- Malpractice RVU 0.98 changed to 0.97
- Malpractice GPCI 0.732 changed to 0.695
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$801.10changed to$801.39
- Conversion factor 35.8043 changed to 35.8887
- Malpractice RVU 1.00 changed to 0.98
- Practice expense GPCI 0.930 changed to 0.931
- Malpractice GPCI 0.768 changed to 0.732
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$806.06changed to$801.10
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 6.12 changed to 6.05
- Malpractice RVU 0.99 changed to 1.00
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$802.05changed to$806.06
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$794.68changed to$802.05
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 6.00 changed to 6.12
- Malpractice RVU 0.86 changed to 0.99
- Practice expense GPCI 0.929 changed to 0.930
- Malpractice GPCI 0.732 changed to 0.768
Held through RVU15B.
January 1, 2014
RVU14A
$769.66changed to$794.68
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 6.49 changed to 6.00
- Malpractice RVU 0.90 changed to 0.86
- Practice expense GPCI 0.927 changed to 0.929
- Malpractice GPCI 0.695 changed to 0.732
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $769.66
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $998.94 | $998.94 | RVU26D |
| 2026-07-01 | $998.94 | $998.94 | RVU26C |
| 2026-04-01 | $998.94 | $998.94 | RVU26B |
| 2026-01-01 | $998.94 | $998.94 | RVU26A |
| 2025-10-01 | $931.43 | $931.43 | RVU25D |
| 2025-07-01 | $931.43 | $931.43 | RVU25C |
| 2025-04-01 | $931.43 | $931.43 | RVU25B |
| 2025-01-01 | $931.43 | $931.43 | RVU25A |
| 2024-10-01 | $957.60 | $957.60 | RVU24D |
| 2024-07-01 | $957.60 | $957.60 | RVU24C |
| 2024-04-01 | $957.60 | $957.60 | RVU24B |
| 2024-03-09 | $957.60 | $957.60 | RVU24AR |
| 2024-01-01 | $941.97 | $941.97 | RVU24A |
| 2023-10-01 | $975.99 | $975.99 | RVU23D |
| 2023-07-01 | $975.99 | $975.99 | RVU23C |
| 2023-04-01 | $975.99 | $975.99 | RVU23B |
| 2023-01-01 | $975.99 | $975.99 | RVU23A |
| 2022-10-01 | $1,005.14 | $1,005.14 | RVU22D |
| 2022-07-01 | $1,005.14 | $1,005.14 | RVU22C |
| 2022-04-01 | $1,005.14 | $1,005.14 | RVU22B |
| 2022-01-01 | $1,005.14 | $1,005.14 | RVU22A |
| 2021-10-01 | $769.44 | $769.44 | RVU21D |
| 2021-07-01 | $769.44 | $769.44 | RVU21C |
| 2021-04-01 | $769.44 | $769.44 | RVU21B |
| 2021-01-01 | $769.44 | $769.44 | RVU21A |
| 2020-10-01 | $808.49 | $808.49 | RVU20D |
| 2020-07-01 | $808.49 | $808.49 | RVU20C |
| 2020-04-01 | $808.49 | $808.49 | RVU20B |
| 2020-01-01 | $808.49 | $808.49 | RVU20A |
| 2019-10-01 | $802.02 | $802.02 | RVU19D |
| 2019-07-01 | $802.02 | $802.02 | RVU19C |
| 2019-04-01 | $802.02 | $802.02 | RVU19B |
| 2019-01-01 | $802.02 | $802.02 | RVU19A |
| 2018-10-01 | $802.31 | $802.31 | RVU18D |
| 2018-07-01 | $802.31 | $802.31 | RVU18C |
| 2018-04-01 | $802.31 | $802.31 | RVU18B |
| 2018-01-01 | $802.31 | $802.31 | RVU18AR1 |
| 2017-10-01 | $801.39 | $801.39 | RVU17D |
| 2017-07-01 | $801.39 | $801.39 | RVU17C |
| 2017-04-01 | $801.39 | $801.39 | RVU17B |
| 2017-01-01 | $801.39 | $801.39 | RVU17A |
| 2016-10-01 | $801.10 | $801.10 | RVU16D |
| 2016-07-01 | $801.10 | $801.10 | RVU16C |
| 2016-04-01 | $801.10 | $801.10 | RVU16B |
| 2016-01-01 | $801.10 | $801.10 | RVU16A |
| 2015-10-01 | $806.06 | $805.72 | RVU15D |
| 2015-07-01 | $806.06 | $805.72 | RVU15C |
| 2015-04-01 | $802.05 | $801.71 | RVU15B |
| 2015-01-01 | $802.05 | $801.71 | RVU15A |
| 2014-10-01 | $794.68 | $794.68 | RVU14D |
| 2014-07-01 | $794.68 | $794.68 | RVU14C |
| 2014-04-01 | $794.68 | $794.68 | RVU14B |
| 2014-01-01 | $794.68 | $794.68 | RVU14A |
| 2013-10-01 | $769.66 | $769.66 | RVU13D |
| 2013-07-01 | $769.66 | $769.66 | RVU13C |
| 2013-04-01 | $769.66 | $769.66 | RVU13B |
| 2013-01-01 | $769.66 | $769.66 | RVU13AR |
Where the North Carolina rate applies
North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.
- Aberdeen
- Advance
- Ahoskie
- Alamance
- Albemarle
- Alexis
- Alliance
- Altamahaw
90954 billing questions
What visit count supports 90954?
Use it for a patient age 2 through 11 when four or more face-to-face visits are documented during the month. The record should support the visits and the related ESRD management.
How does 90954 differ from 90955?
Both are monthly ESRD management codes for patients age 2 through 11. Choose 90954 for four or more visits; 90955 is for two or three.
When should 90956 be selected instead?
90956 is the same-age monthly code for one face-to-face visit. Use 90954 when the documented count reaches four or more.
Is 90954 reported for each dialysis treatment?
No. It represents monthly ESRD-related physician management based on the visit count, not a separate monthly service for each dialysis session.
Which code applies when the patient turns 12?
For a patient age 12 through 19 with four or more face-to-face visits in the month, compare 90957. The applicable age group and documented monthly visit count determine the code.
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
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Your codes at your locality, with payer contracts beside Medicare.
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