CPT code 90955: Monthly ESRD care, ages 2–11, 2–3 visits2026 Medicare rate & RVUs in Virginia
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.
In Virginia, Medicare pays $529.21 for 90955 in the office and $529.21 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 90955 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 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.
How Virginia compares for 90955
Across 109 of 109 payment localities, the office rate for 90955 runs from $503.75 in Arkansas to $712.38 in Alaska. Virginia pays $529.21. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Virginia · this page$529.21
- Los Angeles, CA · California$576.91+$47.70
- Washington, DC area · District of Columbia$590.13+$60.92
- Miami, FL · Florida$578.17+$48.96
- Chicago, IL · Illinois$569.38+$40.17
- Manhattan, NY · New York$600.93+$71.72
- Alaska · Alaska$712.38+$183.17
Other areas in Virginia first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $507.60 | $507.60 |
| ArkansasArkansas | $503.75 | $503.75 |
| ArizonaArizona | $530.00 | $530.00 |
| Bakersfield, CACalifornia | $553.16 | $553.16 |
| Chico, CACalifornia | $550.91 | $550.91 |
| El Centro, CACalifornia | $551.02 | $551.02 |
| Fresno, CACalifornia | $550.91 | $550.91 |
| Hanford, CACalifornia | $550.91 | $550.91 |
| Madera, CACalifornia | $550.91 | $550.91 |
| Merced, CACalifornia | $550.91 | $550.91 |
| Modesto, CACalifornia | $550.91 | $550.91 |
| Napa, CACalifornia | $604.43 | $604.43 |
| Oxnard, CACalifornia | $571.38 | $571.38 |
| Redding, CACalifornia | $550.91 | $550.91 |
| Rest of CaliforniaCalifornia | $550.91 | $550.91 |
| Riverside, CACalifornia | $558.03 | $558.03 |
| Sacramento, CACalifornia | $569.01 | $569.01 |
| Salinas, CACalifornia | $566.59 | $566.59 |
| San Diego, CACalifornia | $572.75 | $572.75 |
| Marin County, CACalifornia | $630.27 | $630.27 |
| San Francisco, CACalifornia | $629.54 | $629.54 |
| San Benito County, CACalifornia | $642.60 | $642.60 |
| Santa Clara County, CACalifornia | $639.63 | $639.63 |
| San Luis Obispo, CACalifornia | $558.32 | $558.32 |
| Santa Cruz, CACalifornia | $572.80 | $572.80 |
| Santa Maria, CACalifornia | $566.77 | $566.77 |
| Santa Rosa, CACalifornia | $578.14 | $578.14 |
| Stockton, CACalifornia | $550.91 | $550.91 |
| Vallejo, CACalifornia | $603.38 | $603.38 |
| Visalia, CACalifornia | $550.91 | $550.91 |
| Yuba City, CACalifornia | $550.91 | $550.91 |
| ColoradoColorado | $548.91 | $548.91 |
| ConnecticutConnecticut | $563.08 | $563.08 |
| DelawareDelaware | $535.92 | $535.92 |
| Fort Lauderdale, FLFlorida | $557.94 | $557.94 |
| Rest of FloridaFlorida | $541.59 | $541.59 |
| Atlanta, GAGeorgia | $546.51 | $546.51 |
| Rest of GeorgiaGeorgia | $523.91 | $523.91 |
| Hawaii, Guam, HIHawaii | $553.03 | $553.03 |
| IowaIowa | $510.88 | $510.88 |
| IdahoIdaho | $513.37 | $513.37 |
| East St. Louis, ILIllinois | $546.31 | $546.31 |
| Rest of IllinoisIllinois | $535.46 | $535.46 |
| Suburban Chicago, ILIllinois | $561.99 | $561.99 |
| IndianaIndiana | $514.85 | $514.85 |
| KansasKansas | $511.27 | $511.27 |
| KentuckyKentucky | $517.47 | $517.47 |
| New Orleans, LALouisiana | $531.16 | $531.16 |
| Rest of LouisianaLouisiana | $517.70 | $517.70 |
| Metropolitan Boston, MAMassachusetts | $583.64 | $583.64 |
| Rest of MassachusettsMassachusetts | $548.73 | $548.73 |
| Baltimore area, MDMaryland | $561.59 | $561.59 |
| Rest of MarylandMaryland | $542.18 | $542.18 |
| Rest of MaineMaine | $516.55 | $516.55 |
| Southern Maine, MEMaine | $528.98 | $528.98 |
| Detroit, MIMichigan | $547.05 | $547.05 |
| Rest of MichiganMichigan | $526.19 | $526.19 |
| MinnesotaMinnesota | $528.37 | $528.37 |
| Metropolitan Kansas City, MOMissouri | $527.42 | $527.42 |
| Metropolitan St. Louis, MOMissouri | $530.19 | $530.19 |
| Rest of MissouriMissouri | $514.08 | $514.08 |
| MississippiMississippi | $508.89 | $508.89 |
| MontanaMontana | $538.38 | $538.38 |
| North CarolinaNorth Carolina | $519.16 | $519.16 |
| North DakotaNorth Dakota | $525.72 | $525.72 |
| NebraskaNebraska | $511.86 | $511.86 |
| New HampshireNew Hampshire | $542.82 | $542.82 |
| Northern New JerseyNew Jersey | $589.17 | $589.17 |
| Rest of New JerseyNew Jersey | $570.14 | $570.14 |
| New MexicoNew Mexico | $528.41 | $528.41 |
| NevadaNevada | $535.02 | $535.02 |
| NYC suburbs and Long Island, NYNew York | $611.38 | $611.38 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $574.80 | $574.80 |
| Queens, NYNew York | $601.30 | $601.30 |
| Rest of New YorkNew York | $523.46 | $523.46 |
| OhioOhio | $523.60 | $523.60 |
| OklahomaOklahoma | $515.21 | $515.21 |
| Portland, OROregon | $557.60 | $557.60 |
| Rest of OregonOregon | $531.38 | $531.38 |
| Metropolitan Philadelphia, PAPennsylvania | $555.82 | $555.82 |
| Rest of PennsylvaniaPennsylvania | $523.11 | $523.11 |
| Puerto RicoPuerto Rico | $540.00 | $540.00 |
| Rhode IslandRhode Island | $548.35 | $548.35 |
| South CarolinaSouth Carolina | $522.12 | $522.12 |
| South DakotaSouth Dakota | $524.23 | $524.23 |
| TennesseeTennessee | $512.84 | $512.84 |
| Austin, TXTexas | $546.67 | $546.67 |
| Beaumont, TXTexas | $521.39 | $521.39 |
| Brazoria, TXTexas | $534.93 | $534.93 |
| Dallas, TXTexas | $537.80 | $537.80 |
| Fort Worth, TXTexas | $536.35 | $536.35 |
| Galveston, TXTexas | $536.30 | $536.30 |
| Houston, TXTexas | $548.01 | $548.01 |
| Rest of TexasTexas | $527.56 | $527.56 |
| UtahUtah | $525.90 | $525.90 |
| Virgin Islands, VIUnited States Virgin Islands | $540.00 | $540.00 |
| VermontVermont | $526.14 | $526.14 |
| Rest of WashingtonWashington | $546.93 | $546.93 |
| King County, WAWashington | $590.87 | $590.87 |
| WisconsinWisconsin | $516.39 | $516.39 |
| West VirginiaWest Virginia | $525.06 | $525.06 |
| WyomingWyoming | $532.86 | $532.86 |
90955 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.
$503.75
$712.38
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 | $712.38 | 1 |
| AL | $507.60 | 1 |
| AR | $503.75 | 1 |
| AZ | $530.00 | 1 |
| CA | $550.91–$642.60 | 29 |
| CO | $548.91 | 1 |
| CT | $563.08 | 1 |
| DC | $590.13 | 1 |
| DE | $535.92 | 1 |
| FL | $541.59–$578.17 | 3 |
| GA | $523.91–$546.51 | 2 |
| GU | $553.03 | 1 |
| HI | $553.03 | 1 |
| IA | $510.88 | 1 |
| ID | $513.37 | 1 |
| IL | $535.46–$569.38 | 4 |
| IN | $514.85 | 1 |
| KS | $511.27 | 1 |
| KY | $517.47 | 1 |
| LA | $517.70–$531.16 | 2 |
| MA | $548.73–$583.64 | 2 |
| MD | $542.18–$590.13 | 3 |
| ME | $516.55–$528.98 | 2 |
| MI | $526.19–$547.05 | 2 |
| MN | $528.37 | 1 |
| MO | $514.08–$530.19 | 3 |
| MS | $508.89 | 1 |
| MT | $538.38 | 1 |
| NC | $519.16 | 1 |
| ND | $525.72 | 1 |
| NE | $511.86 | 1 |
| NH | $542.82 | 1 |
| NJ | $570.14–$589.17 | 2 |
| NM | $528.41 | 1 |
| NV | $535.02 | 1 |
| NY | $523.46–$611.38 | 5 |
| OH | $523.60 | 1 |
| OK | $515.21 | 1 |
| OR | $531.38–$557.60 | 2 |
| PA | $523.11–$555.82 | 2 |
| PR | $540.00 | 1 |
| RI | $548.35 | 1 |
| SC | $522.12 | 1 |
| SD | $524.23 | 1 |
| TN | $512.84 | 1 |
| TX | $521.39–$548.01 | 8 |
| UT | $525.90 | 1 |
| VA | $529.21–$590.13 | 2 |
| VI | $540.00 | 1 |
| VT | $526.14 | 1 |
| WA | $546.93–$590.87 | 2 |
| WI | $516.39 | 1 |
| WV | $525.06 | 1 |
| WY | $532.86 | 1 |
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.
The exact Virginia inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
11,568
- Code
- 90955
- Physician work
- 10.32
- Practice expense
- 5.16
- Malpractice
- 0.64
GPCI2026.csv
106
- Locality
- Virginia
- Physician work
- 1.000
- Practice expense
- 0.983
- Malpractice
- 0.706
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 10.32 | × 1.000 | 10.3200 |
| Practice expense | 5.16 | × 0.983 | 5.0723 |
| Malpractice | 0.64 | × 0.706 | 0.4518 |
| Total RVUs | 15.8441 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Virginia$529.21
Office: (10.32 × 1 + 5.16 × 0.983 + 0.64 × 0.706) × $33.4009 = $529.21
Facility: (10.32 × 1 + 5.16 × 0.983 + 0.64 × 0.706) × $33.4009 = $529.21
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.
How 90955 has changed in Virginia
90955 · Office / nonfacility
$529.21
Effective 2026-10-01
The base rate is $31.97 higher than on 2025-10-01, moving from $497.24 to $529.21 (6.4%).
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
$497.24changed to$529.21
- Conversion factor 32.3465 changed to 33.4009
- Practice expense RVU 4.63 changed to 5.16
- Malpractice RVU 0.63 changed to 0.64
- Work GPCI 1.002 changed to 1.000
- Practice expense GPCI 0.984 changed to 0.983
- Malpractice GPCI 0.755 changed to 0.706
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$508.37changed to$497.24
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 4.49 changed to 4.63
- Malpractice RVU 0.68 changed to 0.63
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$500.08changed to$508.37
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$514.85changed to$500.08
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 4.43 changed to 4.49
- Malpractice RVU 0.59 changed to 0.68
- Work GPCI 1.000 changed to 1.002
- Practice expense GPCI 0.990 changed to 0.984
- Malpractice GPCI 0.826 changed to 0.755
January 1, 2023
RVU23A
$530.57changed to$514.85
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 4.46 changed to 4.43
- Malpractice RVU 0.64 changed to 0.59
- Practice expense GPCI 0.995 changed to 0.990
- Malpractice GPCI 0.897 changed to 0.826
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$531.22changed to$530.57
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 4.37 changed to 4.46
- Malpractice RVU 0.62 changed to 0.64
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$466.15changed to$531.22
- Conversion factor 36.0896 changed to 34.8931
- Work RVU 8.79 changed to 10.32
- Practice expense RVU 3.69 changed to 4.37
- Malpractice RVU 0.52 changed to 0.62
- Practice expense GPCI 0.991 changed to 0.995
- Malpractice GPCI 0.903 changed to 0.897
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$462.46changed to$466.15
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 3.63 changed to 3.69
- Malpractice RVU 0.51 changed to 0.52
- Practice expense GPCI 0.986 changed to 0.991
- Malpractice GPCI 0.908 changed to 0.903
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$461.25changed to$462.46
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 3.61 changed to 3.63
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$459.46changed to$461.25
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 3.59 changed to 3.61
- Malpractice RVU 0.55 changed to 0.51
- Practice expense GPCI 0.985 changed to 0.986
- Malpractice GPCI 0.866 changed to 0.908
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$456.77changed to$459.46
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 3.60 changed to 3.59
- Malpractice RVU 0.52 changed to 0.55
- Practice expense GPCI 0.983 changed to 0.985
- Malpractice GPCI 0.824 changed to 0.866
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$458.77changed to$456.77
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 3.61 changed to 3.60
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$456.48changed to$458.77
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$455.07changed to$456.48
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 3.62 changed to 3.61
- Malpractice RVU 0.47 changed to 0.52
- Practice expense GPCI 0.980 changed to 0.983
- Malpractice GPCI 0.778 changed to 0.824
Held through RVU15B.
January 1, 2014
RVU14A
$441.22changed to$455.07
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 3.91 changed to 3.62
- Malpractice RVU 0.49 changed to 0.47
- Practice expense GPCI 0.977 changed to 0.980
- Malpractice GPCI 0.731 changed to 0.778
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $441.22
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $529.21 | $529.21 | RVU26D |
| 2026-07-01 | $529.21 | $529.21 | RVU26C |
| 2026-04-01 | $529.21 | $529.21 | RVU26B |
| 2026-01-01 | $529.21 | $529.21 | RVU26A |
| 2025-10-01 | $497.24 | $497.24 | RVU25D |
| 2025-07-01 | $497.24 | $497.24 | RVU25C |
| 2025-04-01 | $497.24 | $497.24 | RVU25B |
| 2025-01-01 | $497.24 | $497.24 | RVU25A |
| 2024-10-01 | $508.37 | $508.37 | RVU24D |
| 2024-07-01 | $508.37 | $508.37 | RVU24C |
| 2024-04-01 | $508.37 | $508.37 | RVU24B |
| 2024-03-09 | $508.37 | $508.37 | RVU24AR |
| 2024-01-01 | $500.08 | $500.08 | RVU24A |
| 2023-10-01 | $514.85 | $514.85 | RVU23D |
| 2023-07-01 | $514.85 | $514.85 | RVU23C |
| 2023-04-01 | $514.85 | $514.85 | RVU23B |
| 2023-01-01 | $514.85 | $514.85 | RVU23A |
| 2022-10-01 | $530.57 | $530.57 | RVU22D |
| 2022-07-01 | $530.57 | $530.57 | RVU22C |
| 2022-04-01 | $530.57 | $530.57 | RVU22B |
| 2022-01-01 | $530.57 | $530.57 | RVU22A |
| 2021-10-01 | $531.22 | $531.22 | RVU21D |
| 2021-07-01 | $531.22 | $531.22 | RVU21C |
| 2021-04-01 | $531.22 | $531.22 | RVU21B |
| 2021-01-01 | $531.22 | $531.22 | RVU21A |
| 2020-10-01 | $466.15 | $466.15 | RVU20D |
| 2020-07-01 | $466.15 | $466.15 | RVU20C |
| 2020-04-01 | $466.15 | $466.15 | RVU20B |
| 2020-01-01 | $466.15 | $466.15 | RVU20A |
| 2019-10-01 | $462.46 | $462.46 | RVU19D |
| 2019-07-01 | $462.46 | $462.46 | RVU19C |
| 2019-04-01 | $462.46 | $462.46 | RVU19B |
| 2019-01-01 | $462.46 | $462.46 | RVU19A |
| 2018-10-01 | $461.25 | $461.25 | RVU18D |
| 2018-07-01 | $461.25 | $461.25 | RVU18C |
| 2018-04-01 | $461.25 | $461.25 | RVU18B |
| 2018-01-01 | $461.25 | $461.25 | RVU18AR1 |
| 2017-10-01 | $459.46 | $459.46 | RVU17D |
| 2017-07-01 | $459.46 | $459.46 | RVU17C |
| 2017-04-01 | $459.46 | $459.46 | RVU17B |
| 2017-01-01 | $459.46 | $459.46 | RVU17A |
| 2016-10-01 | $456.77 | $456.77 | RVU16D |
| 2016-07-01 | $456.77 | $456.77 | RVU16C |
| 2016-04-01 | $456.77 | $456.77 | RVU16B |
| 2016-01-01 | $456.77 | $456.77 | RVU16A |
| 2015-10-01 | $458.77 | $458.41 | RVU15D |
| 2015-07-01 | $458.77 | $458.41 | RVU15C |
| 2015-04-01 | $456.48 | $456.13 | RVU15B |
| 2015-01-01 | $456.48 | $456.13 | RVU15A |
| 2014-10-01 | $455.07 | $455.07 | RVU14D |
| 2014-07-01 | $455.07 | $455.07 | RVU14C |
| 2014-04-01 | $455.07 | $455.07 | RVU14B |
| 2014-01-01 | $455.07 | $455.07 | RVU14A |
| 2013-10-01 | $441.22 | $441.22 | RVU13D |
| 2013-07-01 | $441.22 | $441.22 | RVU13C |
| 2013-04-01 | $441.22 | $441.22 | RVU13B |
| 2013-01-01 | $441.22 | $441.22 | RVU13AR |
Where the Virginia rate applies
Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.
- Abbs Valley
- Abingdon
- Accomac
- Adwolf
- Afton
- Alberta
- Aldie
- Allison Gap
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
Show the CMS file lines behind this rate
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