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CPT code 90957: ESRD monthly care, age 12–19, four or more visits2026 Medicare rate & RVUs in West Virginia

Monthly ESRD-related management for a patient age 12 through 19 when the clinician provides at least four face-to-face visits during the month.

CMS RVU26DEffective Oct 1, 2026One payment locality1.3K Medicare services in 2024

In West Virginia, Medicare pays $778.59 for 90957 in the office and $778.59 when it’s performed in a hospital or facility.

$778.59Office (non-facility)
$778.59Hospital or facility
−2.3%vs the national office rate ($796.95)

Check a contract rate as a % of Medicare · 90957 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 90957 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in West Virginia
  2. What 90957 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 90957 covers

Code 90957 represents monthly management of end-stage renal disease for a patient age 12 through 19 who receives four or more face-to-face visits during the month. A nephrologist or other qualified clinician typically provides this care in connection with the patient’s dialysis program. The work may include assessing dialysis adequacy, volume status, nutrition, vascular access, complications, and the ongoing treatment plan, as well as coordinating care with the dialysis team.

Report one monthly service when the age and visit-count criteria are met; this is not a per-dialysis-session code. Documentation should support the patient’s age, the ESRD-related management provided, and at least four face-to-face visits in that calendar month. Select a different monthly code when the patient has fewer qualifying visits, falls into another age band, or receives home dialysis services represented by the home-dialysis series.

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 90957

Across 109 of 109 payment localities, the office rate for 90957 runs from $746.13 in Arkansas to $1,056.55 in Alaska. West Virginia pays $778.59. The RVUs are the same everywhere; the geographic indexes change the dollars.

90957 in West Virginia vs other payment areas
  1. West Virginia · this page$778.59
  2. Los Angeles, CA · California$852.47+$73.88
  3. Washington, DC area · District of Columbia$872.64+$94.05
  4. Miami, FL · Florida$857.16+$78.57
  5. Chicago, IL · Illinois$844.19+$65.60
  6. Manhattan, NY · New York$889.32+$110.73
  7. Alaska · Alaska$1,056.55+$277.96

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

Every other payment area

90957 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$751.76$751.76
ArkansasArkansas$746.13$746.13
ArizonaArizona$784.55$784.55
Bakersfield, CACalifornia$817.75$817.75
Chico, CACalifornia$814.33$814.33
El Centro, CACalifornia$814.49$814.49
Fresno, CACalifornia$814.33$814.33
Hanford, CACalifornia$814.33$814.33

90957 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.

$746.13

$1,056.55

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

View every state and territory as a table
90957 office rate range by state
State / territoryOffice rate rangeLocalities
AK$1,056.551
AL$751.761
AR$746.131
AZ$784.551
CA$814.33–$948.1029
CO$811.831
CT$833.231
DC$872.641
DE$793.251
FL$802.51–$857.163
GA$776.46–$809.042
GU$817.121
HI$817.121
IA$756.141
ID$759.871
IL$793.81–$844.194
IN$762.031
KS$756.921
KY$766.651
LA$767.07–$786.772
MA$811.70–$862.602
MD$802.40–$872.643
ME$764.75–$782.642
MI$779.61–$810.732
MN$781.091
MO$761.89–$785.113
MS$753.951
MT$796.881
NC$768.521
ND$777.501
NE$757.501
NH$803.021
NJ$843.58–$871.362
NM$782.951
NV$791.731
NY$774.83–$904.895
OH$775.651
OK$763.131
OR$786.23–$824.342
PA$774.82–$822.722
PR$799.181
RI$811.401
SC$773.201
SD$775.211
TN$759.241
TX$772.32–$811.658
UT$778.741
VA$783.11–$872.642
VI$799.181
VT$778.301
WA$808.97–$873.032
WI$763.891
WV$778.591
WY$788.431

See 90957 in every payment locality

How the 90957 rate is calculated

Each of 90957’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 · 90957

RVUs × geographic indexes × conversion factor

Office or facility?

Work15.46

15.46 RVUs× 1.000 GPCI

Practice expense7.42

7.42 RVUs× 1.000 GPCI

Malpractice0.98

0.98 RVUs× 1.000 GPCI

Adjusted RVUs

23.8600

Conversion factor

$33.4009

Medicare rate

$796.95

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

11,570

Code
90957
Physician work
15.46
Practice expense
7.42
Malpractice
0.98

GPCI2026.csv

110

Locality
West Virginia
Physician work
1.000
Practice expense
0.869
Malpractice
1.431
Office calculation for 90957 in West Virginia
ComponentRVULocality factorAdjusted
Physician work15.46× 1.00015.4600
Practice expense7.42× 0.8696.4480
Malpractice0.98× 1.4311.4024
Total RVUs23.3104
Conversion factor× 33.4009

Office rate, West Virginia$778.59

Office: (15.46 × 1 + 7.42 × 0.869 + 0.98 × 1.431) × $33.4009 = $778.59

Facility: (15.46 × 1 + 7.42 × 0.869 + 0.98 × 1.431) × $33.4009 = $778.59

Open 90957 in the RVU calculator

Payment rules and modifiers for 90957

90957 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 · 90957

Which rate does Medicare pay?

The POS code on the claim line (CMS-1500 box 24B).

POS 11 · non-facility rate · national

$796.95

Non-facility (office)
$796.95
Facility
$796.95

Higher because the practice carries its own overhead.

Codes related to 90957

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

Codes related to 90957
CodeHow it relatesOffice range, West Virginia
Same family
90958ESRD management, age 12-19, 2-3 visitsMonthly ESRD management for ages 12–19 with two or three face-to-face visits.$505.40
90959ESRD monthly care, age 12–19, one visitMonthly ESRD management for ages 12–19 with one face-to-face visit.$329.01
90954ESRD management, age 2–11, four visitsFour-or-more-visit monthly ESRD management for patients ages 2–11.$1,014.78
90960Monthly ESRD services, age 20+, four or more visitsFour-or-more-visit monthly ESRD management for patients age 20 or older.$361.62
Used instead
90965Home dialysis, ages 12 through 19Monthly ESRD service for a home-dialysis patient age 12–19.$502.59
90969Daily ESRD care, ages 12-19Per-day ESRD service for a patient age 12–19 when a monthly service is not represented.$16.91

How 90957 has changed in West Virginia

90957 · Office / nonfacility

$778.59

Effective 2026-10-01

The base rate is $56.97 higher than on 2025-10-01, moving from $721.62 to $778.59 (7.9%).

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

    $721.62changed to$778.59

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 6.43 changed to 7.42
    • 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

    $740.76changed to$721.62

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 6.35 changed to 6.43
    • Malpractice RVU 0.99 changed to 0.98

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $728.67changed to$740.76

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $747.81changed to$728.67

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 6.27 changed to 6.35
    • Malpractice RVU 0.96 changed to 0.99
    • Practice expense GPCI 0.860 changed to 0.862
    • Malpractice GPCI 1.266 changed to 1.333

  5. January 1, 2023

    RVU23A

    $765.02changed to$747.81

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 6.35 changed to 6.27
    • Malpractice RVU 1.00 changed to 0.96
    • 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

    $764.90changed to$765.02

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 6.19 changed to 6.35
    • Malpractice RVU 0.96 changed to 1.00

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $641.59changed to$764.90

    • Conversion factor 36.0896 changed to 34.8931
    • Work RVU 12.52 changed to 15.46
    • Practice expense RVU 5.00 changed to 6.19
    • Malpractice RVU 0.78 changed to 0.96
    • 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

    $637.73changed to$641.59

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 4.92 changed to 5.00
    • Malpractice RVU 0.74 changed to 0.78
    • Malpractice GPCI 1.296 changed to 1.247

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $637.50changed to$637.73

    • Conversion factor 35.9996 changed to 36.0391
    • Malpractice RVU 0.75 changed to 0.74

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $633.27changed to$637.50

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.91 changed to 4.92
    • 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

    $631.02changed to$633.27

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.94 changed to 4.91
    • Malpractice RVU 0.76 changed to 0.75
    • 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

    $632.70changed to$631.02

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 4.92 changed to 4.94

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $629.55changed to$632.70

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $627.38changed to$629.55

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.96 changed to 4.92
    • Malpractice RVU 0.69 changed to 0.76
    • 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

    $607.63changed to$627.38

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 5.38 changed to 4.96
    • Malpractice RVU 0.72 changed to 0.69
    • 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: $607.63

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$778.59$778.59RVU26D
2026-07-01$778.59$778.59RVU26C
2026-04-01$778.59$778.59RVU26B
2026-01-01$778.59$778.59RVU26A
2025-10-01$721.62$721.62RVU25D
2025-07-01$721.62$721.62RVU25C
2025-04-01$721.62$721.62RVU25B
2025-01-01$721.62$721.62RVU25A
2024-10-01$740.76$740.76RVU24D
2024-07-01$740.76$740.76RVU24C
2024-04-01$740.76$740.76RVU24B
2024-03-09$740.76$740.76RVU24AR
2024-01-01$728.67$728.67RVU24A
2023-10-01$747.81$747.81RVU23D
2023-07-01$747.81$747.81RVU23C
2023-04-01$747.81$747.81RVU23B
2023-01-01$747.81$747.81RVU23A
2022-10-01$765.02$765.02RVU22D
2022-07-01$765.02$765.02RVU22C
2022-04-01$765.02$765.02RVU22B
2022-01-01$765.02$765.02RVU22A
2021-10-01$764.90$764.90RVU21D
2021-07-01$764.90$764.90RVU21C
2021-04-01$764.90$764.90RVU21B
2021-01-01$764.90$764.90RVU21A
2020-10-01$641.59$641.59RVU20D
2020-07-01$641.59$641.59RVU20C
2020-04-01$641.59$641.59RVU20B
2020-01-01$641.59$641.59RVU20A
2019-10-01$637.73$637.73RVU19D
2019-07-01$637.73$637.73RVU19C
2019-04-01$637.73$637.73RVU19B
2019-01-01$637.73$637.73RVU19A
2018-10-01$637.50$637.50RVU18D
2018-07-01$637.50$637.50RVU18C
2018-04-01$637.50$637.50RVU18B
2018-01-01$637.50$637.50RVU18AR1
2017-10-01$633.27$633.27RVU17D
2017-07-01$633.27$633.27RVU17C
2017-04-01$633.27$633.27RVU17B
2017-01-01$633.27$633.27RVU17A
2016-10-01$631.02$631.02RVU16D
2016-07-01$631.02$631.02RVU16C
2016-04-01$631.02$631.02RVU16B
2016-01-01$631.02$631.02RVU16A
2015-10-01$632.70$632.40RVU15D
2015-07-01$632.70$632.40RVU15C
2015-04-01$629.55$629.25RVU15B
2015-01-01$629.55$629.25RVU15A
2014-10-01$627.38$627.38RVU14D
2014-07-01$627.38$627.38RVU14C
2014-04-01$627.38$627.38RVU14B
2014-01-01$627.38$627.38RVU14A
2013-10-01$607.63$607.63RVU13D
2013-07-01$607.63$607.63RVU13C
2013-04-01$607.63$607.63RVU13B
2013-01-01$607.63$607.63RVU13AR

Price 90957 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

90957 billing questions

When should I choose 90957 instead of 90958?

Use 90957 for a patient age 12 through 19 with four or more face-to-face visits during the month. Code 90958 is the same age group with two or three visits.

Is 90957 reported for each dialysis treatment?

No. It represents monthly ESRD-related management, with the number of face-to-face visits determining the applicable monthly code.

What supports reporting four or more visits?

Keep documentation of the face-to-face ESRD-related encounters during the month, along with the assessments and management provided. The record should support the patient’s age and the monthly service.

How does this differ from 90935?

Code 90957 describes monthly ESRD-related management for the specified age and visit count. Code 90935 describes a hemodialysis service with one evaluation, rather than monthly management.

What if the patient received only one visit that month?

For a patient age 12 through 19 with one face-to-face visit, use the corresponding one-visit monthly code, 90959, rather than 90957.

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 90957PPRRVU2026_Oct_nonQPP.csv, line 11,570 (RVU26D)
Geographic factors for West VirginiaGPCI2026.csv, line 110 (RVU26D)

Open CMS sourceHow we calculate rates

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