CPT code 90959: ESRD monthly care, age 12–19, one visit2026 Medicare rate & RVUs

Medicare pays $339.02 for 90959 nationally in the office and $339.02 in a hospital or facility. Local office rates run $315.89–$444.30.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 90959 covers

Code 90959 represents monthly management of end-stage renal disease for a patient age 12 through 19, with one face-to-face visit during the month. A nephrologist or other qualified clinician typically evaluates the patient in connection with ongoing dialysis care, reviews the clinical course and relevant results, and manages issues such as fluid status, dialysis adequacy, anemia, mineral and bone disorders, and vascular access. The service may be furnished in a dialysis facility or another appropriate clinical setting.

Select this code using the patient’s age category and the number of face-to-face visits provided during the month. The record should support the monthly ESRD management, the date and substance of the face-to-face evaluation, and the patient’s age. Report the monthly service once for the applicable month rather than treating each dialysis treatment as a separate monthly service. Distinguish this facility-based monthly series from the separate monthly codes for patients receiving home dialysis.

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 90959 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

90959 rates by state

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

How the 90959 rate is calculated

Each of 90959’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.

Payment rules and modifiers for 90959

90959 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.

90959 compared with similar codes

How to choose

90958ESRD managementAge 12-19, 2-3 visits

Both cover monthly ESRD management for patients age 12 through 19. Choose 90959 for one face-to-face visit and 90958 for two or three.

90957ESRD monthly careAge 12–19, four or more visits

This is the same age-specific monthly series, but 90957 is for four or more face-to-face visits during the month.

90965Home dialysisAges 12 through 19

90965 is the monthly code for home dialysis patients age 12 through 19; 90959 is in the other monthly ESRD service series and specifies one face-to-face visit.

90969Daily ESRD careAges 12-19

90969 reports ESRD services per day for patients age 12 through 19, rather than the monthly service represented by 90959.

Codes related to 90959

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

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

Open CMS sourceHow we calculate rates