CPT code 90955: Monthly ESRD care, ages 2–11, 2–3 visits2026 Medicare rate & RVUs in New York
Monthly ESRD-related management for a patient aged 2–11 when the physician or qualified health care professional provides two or three face-to-face visits.
Medicare pays $523.46–$611.38 for 90955 in the office in New York, from Rest of New York to NYC suburbs and Long Island, NY. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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 in New York
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
5 payment localities
$523.46 to $611.38
| Payment locality | Office | Facility |
|---|---|---|
| Manhattan, NY | $600.93 | $600.93 |
| NYC suburbs and Long Island, NY | $611.38 | $611.38 |
| Poughkeepsie and northern NYC suburbs, NY | $574.80 | $574.80 |
| Queens, NY | $601.30 | $601.30 |
| Rest of New York | $523.46 | $523.46 |
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.
How the rate is built · 90955
RVUs × geographic indexes × conversion factor
Work10.32
10.32 RVUs× 1.000 GPCI
Practice expense5.16
5.16 RVUs× 1.000 GPCI
Malpractice0.64
0.64 RVUs× 1.000 GPCI
Adjusted RVUs
16.1200
Conversion factor
$33.4009
Medicare rate
$538.42
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
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.
Place of service · 90955
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$538.42
- Non-facility (office)
- $538.42
- Facility
- $538.42
Higher because the practice carries its own overhead.
90955 compared with similar codes
Compare codes · National
5 codes, side by side
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.
90955 billing questions
How many visits support 90955?
The patient must be 2 through 11 years old and have two or three qualifying face-to-face visits during the month. The number of dialysis sessions does not determine the visit level.
Should 90955 be reported for each monthly visit?
No. It represents the monthly ESRD-related service, so report it once for the month rather than once per face-to-face visit.
When should 90954 be used instead?
For a patient aged 2 through 11, use 90954 when the monthly visit count meets the four-or-more-visit level. Use 90955 for two or three visits.
What documentation supports 90955?
Document the patient's age, the dates of the two or three face-to-face visits, and the ESRD-related assessment and management furnished at those visits.
Is 90955 for an individual dialysis-session evaluation?
No. It represents monthly ESRD-related care. Codes such as 90935 or 90945 describe evaluation associated with an individual dialysis service, rather than this monthly visit-count service.
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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