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CPT code 90956: ESRD service, ages 2–11, one monthly visit2026 Medicare rate & RVUs in West Virginia

Reports monthly ESRD-related physician services for a patient ages 2–11 when one face-to-face visit is furnished during the month.

CMS RVU26DEffective Oct 1, 2026One payment locality57 Medicare services in 2024

In West Virginia, Medicare pays $355.45 for 90956 in the office and $355.45 when it’s performed in a hospital or facility.

$355.45Office (non-facility)
$355.45Hospital or facility
−3.1%vs the national office rate ($366.74)

Check a contract rate as a % of Medicare · 90956 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 90956 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in West Virginia
  2. What 90956 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 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.

How West Virginia compares for 90956

Across 109 of 109 payment localities, the office rate for 90956 runs from $341.59 in Arkansas to $480.02 in Alaska. West Virginia pays $355.45. The RVUs are the same everywhere; the geographic indexes change the dollars.

90956 in West Virginia vs other payment areas
  1. West Virginia · this page$355.45
  2. Los Angeles, CA · California$395.26+$39.81
  3. Washington, DC area · District of Columbia$403.63+$48.18
  4. Miami, FL · Florida$393.06+$37.61
  5. Chicago, IL · Illinois$386.68+$31.23
  6. Manhattan, NY · New York$410.23+$54.78
  7. Alaska · Alaska$480.02+$124.57

Other areas in West Virginia first, then benchmark localities. Bars start at $0.

Every other payment area

90956 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$344.39$344.39
ArkansasArkansas$341.59$341.59
ArizonaArizona$360.70$360.70
Bakersfield, CACalifornia$378.20$378.20
Chico, CACalifornia$376.76$376.76
El Centro, CACalifornia$376.83$376.83
Fresno, CACalifornia$376.76$376.76
Hanford, CACalifornia$376.76$376.76

90956 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$341.59

$480.02

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
90956 office rate range by state
State / territoryOffice rate rangeLocalities
AK$480.021
AL$344.391
AR$341.591
AZ$360.701
CA$376.76–$442.8029
CO$374.811
CT$384.161
DC$403.631
DE$364.891
FL$367.85–$393.063
GA$355.19–$372.262
GU$378.961
HI$378.961
IA$347.331
ID$349.021
IL$363.03–$386.684
IN$350.121
KS$347.351
KY$351.011
LA$351.07–$360.862
MA$374.47–$399.792
MD$369.41–$403.633
ME$351.06–$360.512
MI$357.09–$371.542
MN$360.911
MO$348.27–$360.473
MS$344.921
MT$366.711
NC$353.001
ND$358.611
NE$348.121
NH$370.411
NJ$389.02–$402.652
NM$358.601
NV$364.591
NY$356.11–$417.485
OH$355.431
OK$349.641
OR$362.15–$381.362
PA$355.22–$378.762
PR$367.981
RI$373.811
SC$354.711
SD$357.651
TN$348.461
TX$353.96–$373.248
UT$357.471
VA$360.48–$403.632
VI$367.981
VT$358.661
WA$373.31–$405.122
WI$351.751
WV$355.451
WY$363.181

See 90956 in every payment locality

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

Office or facility?

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.

The exact West Virginia inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

11,569

Code
90956
Physician work
6.64
Practice expense
3.93
Malpractice
0.41

GPCI2026.csv

110

Locality
West Virginia
Physician work
1.000
Practice expense
0.869
Malpractice
1.431
Office calculation for 90956 in West Virginia
ComponentRVULocality factorAdjusted
Physician work6.64× 1.0006.6400
Practice expense3.93× 0.8693.4152
Malpractice0.41× 1.4310.5867
Total RVUs10.6419
Conversion factor× 33.4009

Office rate, West Virginia$355.45

Office: (6.64 × 1 + 3.93 × 0.869 + 0.41 × 1.431) × $33.4009 = $355.45

Facility: (6.64 × 1 + 3.93 × 0.869 + 0.41 × 1.431) × $33.4009 = $355.45

Open 90956 in the RVU calculator

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.

Codes related to 90956

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 90956
CodeHow it relatesOffice range, West Virginia
Same family
90954ESRD management, age 2–11, four visitsSame age band; represents four or more face-to-face visits during the month.$1,014.78
90955Monthly ESRD care, ages 2–11, 2–3 visitsSame age band; represents two or three face-to-face visits during the month.$525.06
90953Monthly ESRD services, one visit, under age 2One monthly visit, but for patients younger than 2 years.No office rate
90959ESRD monthly care, age 12–19, one visitOne monthly visit for patients ages 12–19.$329.01
90962ESRD monthly care, one visit, age 20+One monthly visit for patients age 20 or older.$206.67
Used instead
90964ESRD services, home dialysis, ages 2–11Monthly ESRD services for home dialysis patients ages 2–11.$520.60
90968ESRD daily care, ages 2–11, partial monthPer-day ESRD service for patients ages 2–11 in a partial-month circumstance.$17.25

How 90956 has changed in West Virginia

90956 · Office / nonfacility

$355.45

Effective 2026-10-01

The base rate is $29.33 higher than on 2025-10-01, moving from $326.12 to $355.45 (9.0%).

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

    $326.12changed to$355.45

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 3.39 changed to 3.93
    • Malpractice RVU 0.39 changed to 0.41
    • Practice expense GPCI 0.862 changed to 0.869
    • Malpractice GPCI 1.333 changed to 1.431

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $333.18changed to$326.12

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 3.29 changed to 3.39
    • Malpractice RVU 0.40 changed to 0.39

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $327.74changed to$333.18

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $334.86changed to$327.74

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 3.21 changed to 3.29
    • Malpractice RVU 0.38 changed to 0.40
    • Practice expense GPCI 0.860 changed to 0.862
    • Malpractice GPCI 1.266 changed to 1.333

  5. January 1, 2023

    RVU23A

    $340.61changed to$334.86

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 3.16 changed to 3.21
    • Malpractice RVU 0.41 changed to 0.38
    • Practice expense GPCI 0.858 changed to 0.860
    • Malpractice GPCI 1.198 changed to 1.266

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $342.47changed to$340.61

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 3.10 changed to 3.16
    • Malpractice RVU 0.43 changed to 0.41

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $315.82changed to$342.47

    • Conversion factor 36.0896 changed to 34.8931
    • Work RVU 5.95 changed to 6.64
    • Practice expense RVU 2.73 changed to 3.10
    • Malpractice RVU 0.37 changed to 0.43
    • Practice expense GPCI 0.857 changed to 0.858
    • Malpractice GPCI 1.247 changed to 1.198

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $314.17changed to$315.82

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 2.70 changed to 2.73
    • Malpractice RVU 0.35 changed to 0.37
    • Malpractice GPCI 1.296 changed to 1.247

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $312.74changed to$314.17

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 2.68 changed to 2.70
    • Malpractice RVU 0.34 changed to 0.35

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $311.51changed to$312.74

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.66 changed to 2.68
    • Malpractice RVU 0.37 changed to 0.34
    • Practice expense GPCI 0.847 changed to 0.857
    • Malpractice GPCI 1.289 changed to 1.296

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $309.92changed to$311.51

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 2.70 changed to 2.66
    • Malpractice RVU 0.35 changed to 0.37
    • Practice expense GPCI 0.836 changed to 0.847
    • Malpractice GPCI 1.282 changed to 1.289

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $312.24changed to$309.92

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 2.74 changed to 2.70

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $310.68changed to$312.24

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $308.17changed to$310.68

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 2.69 changed to 2.74
    • Malpractice RVU 0.33 changed to 0.35
    • Practice expense GPCI 0.832 changed to 0.836
    • Malpractice GPCI 1.256 changed to 1.282

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $298.07changed to$308.17

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.89 changed to 2.69
    • Malpractice RVU 0.34 changed to 0.33
    • Practice expense GPCI 0.828 changed to 0.832
    • Malpractice GPCI 1.229 changed to 1.256

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $298.07

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$355.45$355.45RVU26D
2026-07-01$355.45$355.45RVU26C
2026-04-01$355.45$355.45RVU26B
2026-01-01$355.45$355.45RVU26A
2025-10-01$326.12$326.12RVU25D
2025-07-01$326.12$326.12RVU25C
2025-04-01$326.12$326.12RVU25B
2025-01-01$326.12$326.12RVU25A
2024-10-01$333.18$333.18RVU24D
2024-07-01$333.18$333.18RVU24C
2024-04-01$333.18$333.18RVU24B
2024-03-09$333.18$333.18RVU24AR
2024-01-01$327.74$327.74RVU24A
2023-10-01$334.86$334.86RVU23D
2023-07-01$334.86$334.86RVU23C
2023-04-01$334.86$334.86RVU23B
2023-01-01$334.86$334.86RVU23A
2022-10-01$340.61$340.61RVU22D
2022-07-01$340.61$340.61RVU22C
2022-04-01$340.61$340.61RVU22B
2022-01-01$340.61$340.61RVU22A
2021-10-01$342.47$342.47RVU21D
2021-07-01$342.47$342.47RVU21C
2021-04-01$342.47$342.47RVU21B
2021-01-01$342.47$342.47RVU21A
2020-10-01$315.82$315.82RVU20D
2020-07-01$315.82$315.82RVU20C
2020-04-01$315.82$315.82RVU20B
2020-01-01$315.82$315.82RVU20A
2019-10-01$314.17$314.17RVU19D
2019-07-01$314.17$314.17RVU19C
2019-04-01$314.17$314.17RVU19B
2019-01-01$314.17$314.17RVU19A
2018-10-01$312.74$312.74RVU18D
2018-07-01$312.74$312.74RVU18C
2018-04-01$312.74$312.74RVU18B
2018-01-01$312.74$312.74RVU18AR1
2017-10-01$311.51$311.51RVU17D
2017-07-01$311.51$311.51RVU17C
2017-04-01$311.51$311.51RVU17B
2017-01-01$311.51$311.51RVU17A
2016-10-01$309.92$309.92RVU16D
2016-07-01$309.92$309.92RVU16C
2016-04-01$309.92$309.92RVU16B
2016-01-01$309.92$309.92RVU16A
2015-10-01$312.24$312.24RVU15D
2015-07-01$312.24$312.24RVU15C
2015-04-01$310.68$310.68RVU15B
2015-01-01$310.68$310.68RVU15A
2014-10-01$308.17$308.17RVU14D
2014-07-01$308.17$308.17RVU14C
2014-04-01$308.17$308.17RVU14B
2014-01-01$308.17$308.17RVU14A
2013-10-01$298.07$298.07RVU13D
2013-07-01$298.07$298.07RVU13C
2013-04-01$298.07$298.07RVU13B
2013-01-01$298.07$298.07RVU13AR

Price 90956 for an earlier date of service

Where the West Virginia rate applies

West Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 439 cities and communities in West Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Accoville
  • Addison (Webster Springs)
  • Adrian
  • Albright
  • Alderson
  • Alum Creek
  • Amherstdale
  • Anawalt

Browse all communities in West Virginia

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
RVUs for 90956PPRRVU2026_Oct_nonQPP.csv, line 11,569 (RVU26D)
Geographic factors for West VirginiaGPCI2026.csv, line 110 (RVU26D)

Open CMS sourceHow we calculate rates

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