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CPT code 90958: ESRD management, age 12-19, 2-3 visits2026 Medicare rate & RVUs in Puerto Rico

Monthly ESRD management for patients ages 12 through 19, reported when the physician or qualified professional provides two or three face-to-face visits.

CMS RVU26DEffective Oct 1, 2026One payment locality318 Medicare services in 2024

In Puerto Rico, Medicare pays $520.27 for 90958 in the office and $520.27 when it’s performed in a hospital or facility.

$520.27Office (non-facility)
$520.27Hospital or facility
+0.3%vs the national office rate ($518.72)

Check a contract rate as a % of Medicare · 90958 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 90958 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 90958 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 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.

How Puerto Rico compares for 90958

Across 109 of 109 payment localities, the office rate for 90958 runs from $485.05 in Arkansas to $685.37 in Alaska. Puerto Rico pays $520.27. The RVUs are the same everywhere; the geographic indexes change the dollars.

90958 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$520.27
  2. Los Angeles, CA · California$556.25+$35.98
  3. Washington, DC area · District of Columbia$568.84+$48.57
  4. Miami, FL · Florida$556.78+$36.51
  5. Chicago, IL · Illinois$548.25+$27.98
  6. Manhattan, NY · New York$579.08+$58.81
  7. Alaska · Alaska$685.37+$165.10

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

90958 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$488.79$488.79
ArkansasArkansas$485.05$485.05
ArizonaArizona$510.55$510.55
Bakersfield, CACalifornia$533.21$533.21
Chico, CACalifornia$531.06$531.06
El Centro, CACalifornia$531.16$531.16
Fresno, CACalifornia$531.06$531.06
Hanford, CACalifornia$531.06$531.06

90958 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.

$485.05

$685.37

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

View every state and territory as a table
90958 office rate range by state
State / territoryOffice rate rangeLocalities
AK$685.371
AL$488.791
AR$485.051
AZ$510.551
CA$531.06–$620.0829
CO$529.011
CT$542.581
DC$568.841
DE$516.281
FL$521.54–$556.783
GA$504.41–$526.502
GU$533.251
HI$533.251
IA$492.091
ID$494.481
IL$515.51–$548.254
IN$495.931
KS$492.421
KY$498.261
LA$498.46–$511.542
MA$528.79–$562.712
MD$522.37–$568.843
ME$497.52–$509.682
MI$506.67–$526.792
MN$509.261
MO$494.91–$510.663
MS$489.951
MT$518.681
NC$500.061
ND$506.611
NE$493.061
NH$523.081
NJ$549.40–$567.862
NM$508.811
NV$515.481
NY$504.23–$589.165
OH$504.201
OK$496.121
OR$511.99–$537.502
PA$503.76–$535.502
PR$520.271
RI$528.351
SC$502.841
SD$505.191
TN$493.931
TX$502.09–$527.838
UT$506.521
VA$509.86–$568.842
VI$520.271
VT$506.961
WA$527.07–$569.762
WI$497.531
WV$505.401
WY$513.421

See 90958 in every payment locality

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

Office or facility?

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.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

11,571

Code
90958
Physician work
9.87
Practice expense
5.05
Malpractice
0.61

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 90958 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work9.87× 1.0009.8700
Practice expense5.05× 1.0115.1055
Malpractice0.61× 0.9850.6008
Total RVUs15.5764
Conversion factor× 33.4009

Office rate, Puerto Rico$520.27

Office: (9.87 × 1 + 5.05 × 1.011 + 0.61 × 0.985) × $33.4009 = $520.27

Facility: (9.87 × 1 + 5.05 × 1.011 + 0.61 × 0.985) × $33.4009 = $520.27

Open 90958 in the RVU calculator

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.

Codes related to 90958

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

Codes related to 90958
CodeHow it relatesOffice range, Puerto Rico
Same family
90957ESRD monthly care, age 12–19, four or more visitsMonthly ESRD management for ages 12-19 at the four-face-to-face-visit tier.$799.18
90959ESRD monthly care, age 12–19, one visitMonthly ESRD management for ages 12-19 at the one-face-to-face-visit tier.$340.14
90955Monthly ESRD care, ages 2–11, 2–3 visitsMonthly two-to-three-visit tier for patients ages 2-11.$540.00
90961ESRD management, 2-3 visits, age 20+Monthly two-to-three-visit tier for patients age 20 and older.$311.70
Used instead
90969Daily ESRD care, ages 12-19Per-day ESRD services for ages 12-19 when reporting the daily rather than monthly service.$17.42

How 90958 has changed in Puerto Rico

90958 · Office / nonfacility

$520.27

Effective 2026-10-01

The base rate is $37.68 higher than on 2025-10-01, moving from $482.59 to $520.27 (7.8%).

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

    $482.59changed to$520.27

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 4.40 changed to 5.05
    • Malpractice RVU 0.63 changed to 0.61
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $494.63changed to$482.59

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 4.35 changed to 4.40
    • Malpractice RVU 0.62 changed to 0.63

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $486.56changed to$494.63

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $500.67changed to$486.56

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.28 changed to 4.35
    • Malpractice RVU 0.60 changed to 0.62
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $499.84changed to$500.67

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $514.46changed to$499.84

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.35 changed to 4.28
    • Malpractice RVU 0.62 changed to 0.60
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $514.50changed to$514.46

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 4.23 changed to 4.35

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $449.41changed to$514.50

    • Conversion factor 36.0896 changed to 34.8931
    • Work RVU 8.34 changed to 9.87
    • Practice expense RVU 3.58 changed to 4.23
    • Malpractice RVU 0.51 changed to 0.62
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $445.44changed to$449.41

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.52 changed to 3.58
    • Malpractice RVU 0.48 changed to 0.51
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $444.94changed to$445.44

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 3.51 changed to 3.52
    • Malpractice RVU 0.49 changed to 0.48

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $417.20changed to$444.94

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.47 changed to 3.51
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $391.84changed to$417.20

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 3.49 changed to 3.47
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $392.39changed to$391.84

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 3.46 changed to 3.49
    • Malpractice RVU 0.48 changed to 0.49

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $390.44changed to$392.39

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $389.74changed to$390.44

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 3.49 changed to 3.46
    • Malpractice RVU 0.46 changed to 0.48
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $376.40changed to$389.74

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 3.84 changed to 3.49
    • Malpractice RVU 0.48 changed to 0.46
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $376.40

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$520.27$520.27RVU26D
2026-07-01$520.27$520.27RVU26C
2026-04-01$520.27$520.27RVU26B
2026-01-01$520.27$520.27RVU26A
2025-10-01$482.59$482.59RVU25D
2025-07-01$482.59$482.59RVU25C
2025-04-01$482.59$482.59RVU25B
2025-01-01$482.59$482.59RVU25A
2024-10-01$494.63$494.63RVU24D
2024-07-01$494.63$494.63RVU24C
2024-04-01$494.63$494.63RVU24B
2024-03-09$494.63$494.63RVU24AR
2024-01-01$486.56$486.56RVU24A
2023-10-01$500.67$500.67RVU23D
2023-07-01$499.84$499.84RVU23C
2023-04-01$499.84$499.84RVU23B
2023-01-01$499.84$499.84RVU23A
2022-10-01$514.46$514.46RVU22D
2022-07-01$514.46$514.46RVU22C
2022-04-01$514.46$514.46RVU22B
2022-01-01$514.46$514.46RVU22A
2021-10-01$514.50$514.50RVU21D
2021-07-01$514.50$514.50RVU21C
2021-04-01$514.50$514.50RVU21B
2021-01-01$514.50$514.50RVU21A
2020-10-01$449.41$449.41RVU20D
2020-07-01$449.41$449.41RVU20C
2020-04-01$449.41$449.41RVU20B
2020-01-01$449.41$449.41RVU20A
2019-10-01$445.44$445.44RVU19D
2019-07-01$445.44$445.44RVU19C
2019-04-01$445.44$445.44RVU19B
2019-01-01$445.44$445.44RVU19A
2018-10-01$444.94$444.94RVU18D
2018-07-01$444.94$444.94RVU18C
2018-04-01$444.94$444.94RVU18B
2018-01-01$444.94$444.94RVU18AR1
2017-10-01$417.20$417.20RVU17D
2017-07-01$417.20$417.20RVU17C
2017-04-01$417.20$417.20RVU17B
2017-01-01$417.20$417.20RVU17A
2016-10-01$391.84$391.84RVU16D
2016-07-01$391.84$391.84RVU16C
2016-04-01$391.84$391.84RVU16B
2016-01-01$391.84$391.84RVU16A
2015-10-01$392.39$392.14RVU15D
2015-07-01$392.39$392.14RVU15C
2015-04-01$390.44$390.19RVU15B
2015-01-01$390.44$390.19RVU15A
2014-10-01$389.74$389.74RVU14D
2014-07-01$389.74$389.74RVU14C
2014-04-01$389.74$389.74RVU14B
2014-01-01$389.74$389.74RVU14A
2013-10-01$376.40$376.40RVU13D
2013-07-01$376.40$376.40RVU13C
2013-04-01$376.40$376.40RVU13B
2013-01-01$376.40$376.40RVU13AR

Price 90958 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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
RVUs for 90958PPRRVU2026_Oct_nonQPP.csv, line 11,571 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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