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.

CMS RVU26DEffective Oct 1, 2026One payment locality368 Medicare services in 2024

In North Carolina, Medicare pays $998.94 for 90954 in the office and $998.94 when it’s performed in a hospital or facility.

$998.94Office (non-facility)
$998.94Hospital or facility
−3.4%vs the national office rate ($1,034.43)

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.

We’ll open 90954 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Carolina
  2. What 90954 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

90954 in North Carolina vs other payment areas
  1. North Carolina · this page$998.94
  2. Los Angeles, CA · California$1,102.08+$103.14
  3. Washington, DC area · District of Columbia$1,129.31+$130.37
  4. Miami, FL · Florida$1,113.38+$114.44
  5. Chicago, IL · Illinois$1,097.44+$98.50
  6. Manhattan, NY · New York$1,152.27+$153.33
  7. Alaska · Alaska$1,382.26+$383.32

Other areas in North Carolina first, then benchmark localities. Bars start at $0.

Every other payment area

90954 in every other Medicare payment locality
Payment localityOfficeFacility
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

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
90954 office rate range by state
State / territoryOffice rate rangeLocalities
AK$1,382.261
AL$978.701
AR$971.761
AZ$1,019.011
CA$1,054.19–$1,220.6829
CO$1,052.021
CT$1,080.181
DC$1,129.311
DE$1,029.961
FL$1,043.50–$1,113.383
GA$1,011.08–$1,050.012
GU$1,056.271
HI$1,056.271
IA$983.061
ID$987.851
IL$1,033.49–$1,097.444
IN$990.481
KS$984.511
KY$998.081
LA$998.79–$1,023.032
MA$1,052.27–$1,115.202
MD$1,041.33–$1,129.313
ME$994.37–$1,015.632
MI$1,014.50–$1,054.152
MN$1,012.151
MO$992.73–$1,020.403
MS$982.151
MT$1,034.341
NC$998.941
ND$1,008.441
NE$984.581
NH$1,041.011
NJ$1,093.58–$1,128.322
NM$1,018.821
NV$1,027.411
NY$1,006.73–$1,172.075
OH$1,009.201
OK$993.221
OR$1,020.25–$1,067.002
PA$1,007.92–$1,067.462
PR$1,037.001
RI$1,052.641
SC$1,005.521
SD$1,005.371
TN$987.421
TX$1,004.87–$1,054.398
UT$1,012.331
VA$1,016.57–$1,129.312
VI$1,037.001
VT$1,009.871
WA$1,048.60–$1,127.982
WI$991.801
WV$1,014.781
WY$1,023.051

See 90954 in every payment locality

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

Office or facility?

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
Office calculation for 90954 in North Carolina
ComponentRVULocality factorAdjusted
Physician work20.86× 1.00020.8600
Practice expense8.80× 0.9338.2104
Malpractice1.31× 0.6390.8371
Total RVUs29.9075
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

Open 90954 in the RVU calculator

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.

Base rate by release · bars start at $0 · select a bar to compare

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
  1. 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.

  2. 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.

  3. March 9, 2024

    RVU24AR

    $941.97changed to$957.60

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. 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
  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. July 1, 2015

    RVU15C

    $802.05changed to$806.06

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. 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.

  15. 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.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $769.66

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$998.94$998.94RVU26D
2026-07-01$998.94$998.94RVU26C
2026-04-01$998.94$998.94RVU26B
2026-01-01$998.94$998.94RVU26A
2025-10-01$931.43$931.43RVU25D
2025-07-01$931.43$931.43RVU25C
2025-04-01$931.43$931.43RVU25B
2025-01-01$931.43$931.43RVU25A
2024-10-01$957.60$957.60RVU24D
2024-07-01$957.60$957.60RVU24C
2024-04-01$957.60$957.60RVU24B
2024-03-09$957.60$957.60RVU24AR
2024-01-01$941.97$941.97RVU24A
2023-10-01$975.99$975.99RVU23D
2023-07-01$975.99$975.99RVU23C
2023-04-01$975.99$975.99RVU23B
2023-01-01$975.99$975.99RVU23A
2022-10-01$1,005.14$1,005.14RVU22D
2022-07-01$1,005.14$1,005.14RVU22C
2022-04-01$1,005.14$1,005.14RVU22B
2022-01-01$1,005.14$1,005.14RVU22A
2021-10-01$769.44$769.44RVU21D
2021-07-01$769.44$769.44RVU21C
2021-04-01$769.44$769.44RVU21B
2021-01-01$769.44$769.44RVU21A
2020-10-01$808.49$808.49RVU20D
2020-07-01$808.49$808.49RVU20C
2020-04-01$808.49$808.49RVU20B
2020-01-01$808.49$808.49RVU20A
2019-10-01$802.02$802.02RVU19D
2019-07-01$802.02$802.02RVU19C
2019-04-01$802.02$802.02RVU19B
2019-01-01$802.02$802.02RVU19A
2018-10-01$802.31$802.31RVU18D
2018-07-01$802.31$802.31RVU18C
2018-04-01$802.31$802.31RVU18B
2018-01-01$802.31$802.31RVU18AR1
2017-10-01$801.39$801.39RVU17D
2017-07-01$801.39$801.39RVU17C
2017-04-01$801.39$801.39RVU17B
2017-01-01$801.39$801.39RVU17A
2016-10-01$801.10$801.10RVU16D
2016-07-01$801.10$801.10RVU16C
2016-04-01$801.10$801.10RVU16B
2016-01-01$801.10$801.10RVU16A
2015-10-01$806.06$805.72RVU15D
2015-07-01$806.06$805.72RVU15C
2015-04-01$802.05$801.71RVU15B
2015-01-01$802.05$801.71RVU15A
2014-10-01$794.68$794.68RVU14D
2014-07-01$794.68$794.68RVU14C
2014-04-01$794.68$794.68RVU14B
2014-01-01$794.68$794.68RVU14A
2013-10-01$769.66$769.66RVU13D
2013-07-01$769.66$769.66RVU13C
2013-04-01$769.66$769.66RVU13B
2013-01-01$769.66$769.66RVU13AR

Price 90954 for an earlier date of service

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

Browse all communities in North Carolina

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

Show the CMS file lines behind this rate
RVUs for 90954PPRRVU2026_Oct_nonQPP.csv, line 11,567 (RVU26D)
Geographic factors for North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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