CPT code 90956: ESRD service, ages 2–11, one monthly visit2026 Medicare rate & RVUs in Missouri
Reports monthly ESRD-related physician services for a patient ages 2–11 when one face-to-face visit is furnished during the month.
Medicare pays $348.27–$360.47 for 90956 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. 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 90956 covers
This code represents monthly ESRD-related care for a patient who is 2 through 11 years old and receives one face-to-face visit during the month. A nephrologist commonly provides the visit in a dialysis setting, reviewing the child’s clinical course and addressing ESRD management needs such as dialysis tolerance, fluid status, laboratory findings, medications, and growth or nutrition concerns. It represents monthly care, not a separate evaluation for each dialysis treatment.
Select the code by the patient’s age and the number of face-to-face visits furnished in the month. Documentation should support the patient’s age, the date and substance of the visit, and the ESRD-related management performed. Use the corresponding sibling when the monthly visit count or age band differs; the home-dialysis monthly series and per-day services describe different circumstances. CMS assigns physician fee schedule values 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.
Where 90956 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$348.27 to $360.47
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $358.42 | $358.42 |
| Metropolitan St. Louis, MO | $360.47 | $360.47 |
| Rest of Missouri | $348.27 | $348.27 |
How the 90956 rate is calculated
Each of 90956’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 · 90956
RVUs × geographic indexes × conversion factor
Work6.64
6.64 RVUs× 1.000 GPCI
Practice expense3.93
3.93 RVUs× 1.000 GPCI
Malpractice0.41
0.41 RVUs× 1.000 GPCI
Adjusted RVUs
10.9800
Conversion factor
$33.4009
Medicare rate
$366.74
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 90956
90956 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 · 90956
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$366.74
- Non-facility (office)
- $366.74
- Facility
- $366.74
Higher because the practice carries its own overhead.
90956 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 90955Monthly ESRD careAges 2–11, 2–3 visits
- Both codes cover monthly ESRD services for patients ages 2–11. Choose 90956 for one face-to-face visit and 90955 for two or three.
- 90954ESRD managementAge 2–11, four visits
- This sibling covers the same pediatric age band but represents four or more face-to-face visits during the month.
- 90964ESRD servicesHome dialysis, ages 2–11
- 90964 is the monthly ESRD service code for home dialysis patients ages 2–11; 90956 is selected by the one-visit monthly band.
- 90968ESRD daily careAges 2–11, partial month
- 90968 reports ESRD services per day for patients ages 2–11, rather than the monthly service represented by 90956.
90956 billing questions
When is 90956 selected instead of 90955?
Use 90956 for a patient ages 2–11 with one face-to-face visit during the month. Code 90955 represents the same age band when two or three visits are furnished.
Does this code represent each dialysis treatment?
No. It represents monthly ESRD-related services and is selected by monthly face-to-face visit count, not by the number of dialysis sessions.
What documentation supports reporting 90956?
Record the patient’s age, the face-to-face visit date, and the ESRD-related assessment and management performed during the visit.
Can 90956 be used for a partial month?
The code describes monthly services with one visit. Per-day ESRD services are represented by a separate code series for partial-month circumstances.
Is 90956 the monthly code for home dialysis?
No. The ESRD monthly series has a separate code for home dialysis patients ages 2–11; select according to the applicable patient and service circumstances.
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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