CPT code 90958: ESRD management, age 12-19, 2-3 visits2026 Medicare rate & RVUs in Guam
Monthly ESRD management for patients ages 12 through 19, reported when the physician or qualified professional provides two or three face-to-face visits.
Medicare pays $533.25 for 90958 in the office in Guam (Hawaii, Guam, HI). 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 90958 covers
This monthly service covers a physician’s or qualified health care professional’s management of a patient ages 12 through 19 receiving treatment for end-stage renal disease. A nephrologist commonly provides the visits in a dialysis facility, hospital, or office, addressing the patient’s dialysis plan and related clinical needs, such as treatment response, laboratory findings, medications, and dialysis-related complications. The code’s visit tier is based on two or three face-to-face visits during the month, not on the number of dialysis sessions the patient receives.
Report the monthly code when the patient’s age and documented face-to-face visit count match this tier. The record should identify the services and visit dates supporting ongoing ESRD management. It is one monthly service, not a separate unit for each encounter or dialysis treatment. CMS payment is based on the physician fee schedule values for this code.
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.
90958 in Hawaii, Guam, HI
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam, HI | $533.25 | $533.25 |
How the 90958 rate is calculated
Each of 90958’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 · 90958
RVUs × geographic indexes × conversion factor
Work9.87
9.87 RVUs× 1.000 GPCI
Practice expense5.05
5.05 RVUs× 1.000 GPCI
Malpractice0.61
0.61 RVUs× 1.000 GPCI
Adjusted RVUs
15.5300
Conversion factor
$33.4009
Medicare rate
$518.72
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 90958
90958 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 · 90958
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$518.72
- Non-facility (office)
- $518.72
- Facility
- $518.72
Higher because the practice carries its own overhead.
90958 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 90957ESRD monthly careAge 12–19, four or more visits
- Both cover monthly ESRD management for ages 12-19; 90957 is the four-visit tier, while 90958 is for two or three visits.
- 90959ESRD monthly careAge 12–19, one visit
- 90959 is the one-visit monthly tier for ages 12-19. Choose 90958 when two or three face-to-face visits support the monthly service.
- 90961ESRD management2-3 visits, age 20+
- 90961 has the same two-to-three-visit monthly tier but applies to patients age 20 and older; 90958 is for ages 12-19.
- 90969Daily ESRD careAges 12-19
- 90969 reports ESRD services per day for ages 12-19, rather than the monthly two-to-three-visit service represented by 90958.
90958 billing questions
How does 90958 differ from 90957?
Both are monthly ESRD management codes for patients ages 12 through 19. Use 90958 for two or three face-to-face visits; 90957 is the four-visit tier.
Can 90958 be reported when there is only one face-to-face visit?
No. The one-visit monthly tier for a patient ages 12 through 19 is 90959.
Do dialysis sessions count as the face-to-face visits?
The tier is based on face-to-face visits for monthly ESRD management, not simply the number of dialysis treatments. Document the management encounters and their dates.
What code applies if ESRD services cover only part of the month?
90969 is the per-day ESRD services code for patients ages 12 through 19. It differs from 90958’s monthly visit-count tier.
Is 90958 reported once for each visit?
No. It represents the monthly service at the two-to-three-visit level, rather than a separate unit for each face-to-face encounter.
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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