CPT code 90955: Monthly ESRD care, ages 2–11, 2–3 visits2026 Medicare rate & RVUs

Medicare pays $538.42 for 90955 nationally in the office and $538.42 in a hospital or facility. Local office rates run $503.75–$712.38.

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

What 90955 covers

CPT 90955 represents monthly end-stage renal disease (ESRD)-related care for a patient aged 2 through 11 when the physician or qualified health care professional conducts two or three face-to-face visits during the month. Pediatric nephrologists commonly report it while managing children receiving maintenance dialysis. Monthly care may involve reviewing the dialysis plan, volume and blood-pressure status, laboratory results, medications, vascular or peritoneal access concerns, and treatment complications. This is monthly management, not a code for an individual dialysis treatment.

Choose the code by the patient’s age and the number of qualifying face-to-face visits during the month. The record should support the visit dates and the renal management provided; count these visits, not dialysis sessions. Report the monthly service once for the applicable month, rather than assigning 90955 to each visit. CMS assigns work, practice-expense, and malpractice relative value units to the 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 90955 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

90955 rates by state

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

How the 90955 rate is calculated

Each of 90955’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 90955

90955 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.

90955 compared with similar codes

How to choose

90954ESRD managementAge 2–11, four visits

Both cover monthly ESRD-related care for patients aged 2 through 11. Choose 90954 for four or more face-to-face visits, not two or three.

90956ESRD serviceAges 2–11, one monthly visit

This is the one-visit monthly level for patients aged 2 through 11; 90955 is for two or three visits.

90958ESRD managementAge 12-19, 2-3 visits

This covers two or three monthly visits for patients aged 12 through 19. Use 90955 for the same visit range when the patient is aged 2 through 11.

90945Dialysis evaluationOther than hemodialysis, single evaluation

90945 describes evaluation associated with an individual dialysis service other than hemodialysis. 90955 represents monthly ESRD-related care selected by age and face-to-face visit count.

Codes related to 90955

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