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

Monthly ESRD-related management for a patient age 12 through 19 when one face-to-face visit is provided during the month.

CMS RVU26DEffective Oct 1, 2026One payment locality204 Medicare services in 2024

In Delaware, Medicare pays $337.31 for 90959 in the office and $337.31 when it’s performed in a hospital or facility.

$337.31Office (non-facility)
$337.31Hospital or facility
−0.5%vs the national office rate ($339.02)

Check a contract rate as a % of Medicare · 90959 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 90959 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Delaware
  2. What 90959 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 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.

How Delaware compares for 90959

Across 109 of 109 payment localities, the office rate for 90959 runs from $315.89 in Arkansas to $444.30 in Alaska. Delaware pays $337.31. The RVUs are the same everywhere; the geographic indexes change the dollars.

90959 in Delaware vs other payment areas
  1. Delaware · this page$337.31
  2. Los Angeles, CA · California$364.94+$27.63
  3. Washington, DC area · District of Columbia$372.88+$35.57
  4. Miami, FL · Florida$363.83+$26.52
  5. Chicago, IL · Illinois$357.93+$20.62
  6. Manhattan, NY · New York$379.20+$41.89
  7. Alaska · Alaska$444.30+$106.99

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

Every other payment area

90959 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$318.46$318.46
ArkansasArkansas$315.89$315.89
ArizonaArizona$333.45$333.45
Bakersfield, CACalifornia$349.30$349.30
Chico, CACalifornia$347.94$347.94
El Centro, CACalifornia$348.00$348.00
Fresno, CACalifornia$347.94$347.94
Hanford, CACalifornia$347.94$347.94

90959 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.

$315.89

$444.30

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

View every state and territory as a table
90959 office rate range by state
State / territoryOffice rate rangeLocalities
AK$444.301
AL$318.461
AR$315.891
AZ$333.451
CA$347.94–$408.4229
CO$346.281
CT$355.071
DC$372.881
DE$337.311
FL$340.32–$363.833
GA$328.64–$344.172
GU$349.871
HI$349.871
IA$321.031
ID$322.611
IL$335.98–$357.934
IN$323.621
KS$321.111
KY$324.681
LA$324.76–$333.762
MA$346.00–$369.202
MD$341.45–$372.883
ME$324.56–$333.142
MI$330.33–$343.782
MN$333.311
MO$322.23–$333.323
MS$319.041
MT$338.991
NC$326.331
ND$331.281
NE$321.741
NH$342.281
NJ$359.52–$372.012
NM$331.741
NV$336.961
NY$329.19–$385.955
OH$328.751
OK$323.361
OR$334.67–$352.232
PA$328.52–$350.142
PR$340.141
RI$345.481
SC$328.001
SD$330.371
TN$322.141
TX$327.36–$344.868
UT$330.541
VA$333.16–$372.882
VI$340.141
VT$331.391
WA$344.91–$374.042
WI$325.001
WV$329.011
WY$335.631

See 90959 in every payment locality

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.

How the rate is built · 90959

RVUs × geographic indexes × conversion factor

Office or facility?

Work6.19

6.19 RVUs× 1.000 GPCI

Practice expense3.57

3.57 RVUs× 1.000 GPCI

Malpractice0.39

0.39 RVUs× 1.000 GPCI

Adjusted RVUs

10.1500

Conversion factor

$33.4009

Medicare rate

$339.02

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Delaware inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

11,572

Code
90959
Physician work
6.19
Practice expense
3.57
Malpractice
0.39

GPCI2026.csv

40

Locality
Delaware
Physician work
1.005
Practice expense
0.988
Malpractice
0.899
Office calculation for 90959 in Delaware
ComponentRVULocality factorAdjusted
Physician work6.19× 1.0056.2209
Practice expense3.57× 0.9883.5272
Malpractice0.39× 0.8990.3506
Total RVUs10.0987
Conversion factor× 33.4009

Office rate, Delaware$337.31

Office: (6.19 × 1.005 + 3.57 × 0.988 + 0.39 × 0.899) × $33.4009 = $337.31

Facility: (6.19 × 1.005 + 3.57 × 0.988 + 0.39 × 0.899) × $33.4009 = $337.31

Open 90959 in the RVU calculator

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.

Place of service · 90959

Which rate does Medicare pay?

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

POS 11 · non-facility rate · national

$339.02

Non-facility (office)
$339.02
Facility
$339.02

Higher because the practice carries its own overhead.

Codes related to 90959

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

Codes related to 90959
CodeHow it relatesOffice range, Delaware
Same family
90958ESRD management, age 12-19, 2-3 visitsSame age group, with two or three face-to-face visits during the month.$516.28
90957ESRD monthly care, age 12–19, four or more visitsSame age group, with four or more face-to-face visits during the month.$793.25
90956ESRD service, ages 2–11, one monthly visitOne monthly visit, but for patients age 2 through 11.$364.89
Used instead
90965Home dialysis, ages 12 through 19Monthly ESRD services for a home dialysis patient age 12 through 19.$513.63
90969Daily ESRD care, ages 12-19Per-day ESRD services for a patient age 12 through 19.$17.29

How 90959 has changed in Delaware

90959 · Office / nonfacility

$337.31

Effective 2026-10-01

The base rate is $22.24 higher than on 2025-10-01, moving from $315.07 to $337.31 (7.1%).

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

    $315.07changed to$337.31

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 3.15 changed to 3.57
    • Work GPCI 1.009 changed to 1.005
    • Practice expense GPCI 0.992 changed to 0.988
    • Malpractice GPCI 0.949 changed to 0.899

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $322.58changed to$315.07

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 3.09 changed to 3.15
    • Malpractice RVU 0.40 changed to 0.39

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $317.31changed to$322.58

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $326.02changed to$317.31

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 3.01 changed to 3.09
    • Malpractice RVU 0.38 changed to 0.40
    • Work GPCI 1.007 changed to 1.009
    • Practice expense GPCI 1.007 changed to 0.992
    • Malpractice GPCI 0.938 changed to 0.949

  5. January 1, 2023

    RVU23A

    $334.25changed to$326.02

    • Conversion factor 34.6062 changed to 33.8872
    • Malpractice RVU 0.39 changed to 0.38
    • Work GPCI 1.005 changed to 1.007
    • Practice expense GPCI 1.022 changed to 1.007
    • Malpractice GPCI 0.927 changed to 0.938

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $333.85changed to$334.25

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 2.93 changed to 3.01
    • Malpractice RVU 0.38 changed to 0.39

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $306.93changed to$333.85

    • Conversion factor 36.0896 changed to 34.8931
    • Work RVU 5.50 changed to 6.19
    • Practice expense RVU 2.57 changed to 2.93
    • Malpractice RVU 0.34 changed to 0.38
    • Work GPCI 1.006 changed to 1.005
    • Practice expense GPCI 1.021 changed to 1.022
    • Malpractice GPCI 1.023 changed to 0.927

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $307.29changed to$306.93

    • Conversion factor 36.0391 changed to 36.0896
    • Malpractice RVU 0.33 changed to 0.34
    • Work GPCI 1.007 changed to 1.006
    • Practice expense GPCI 1.019 changed to 1.021
    • Malpractice GPCI 1.119 changed to 1.023

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $306.18changed to$307.29

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 2.56 changed to 2.57
    • Malpractice RVU 0.32 changed to 0.33

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $305.44changed to$306.18

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.54 changed to 2.56
    • Work GPCI 1.010 changed to 1.007
    • Practice expense GPCI 1.025 changed to 1.019
    • Malpractice GPCI 1.101 changed to 1.119

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $305.83changed to$305.44

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 2.55 changed to 2.54
    • Work GPCI 1.012 changed to 1.010
    • Practice expense GPCI 1.031 changed to 1.025
    • Malpractice GPCI 1.083 changed to 1.101

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $306.19changed to$305.83

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 2.53 changed to 2.55

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $304.67changed to$306.19

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $302.53changed to$304.67

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 2.52 changed to 2.53
    • Malpractice RVU 0.30 changed to 0.32
    • Practice expense GPCI 1.038 changed to 1.031
    • Malpractice GPCI 0.878 changed to 1.083

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $295.21changed to$302.53

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.78 changed to 2.52
    • Malpractice RVU 0.31 changed to 0.30
    • Practice expense GPCI 1.044 changed to 1.038
    • Malpractice GPCI 0.672 changed to 0.878

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $295.21

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$337.31$337.31RVU26D
2026-07-01$337.31$337.31RVU26C
2026-04-01$337.31$337.31RVU26B
2026-01-01$337.31$337.31RVU26A
2025-10-01$315.07$315.07RVU25D
2025-07-01$315.07$315.07RVU25C
2025-04-01$315.07$315.07RVU25B
2025-01-01$315.07$315.07RVU25A
2024-10-01$322.58$322.58RVU24D
2024-07-01$322.58$322.58RVU24C
2024-04-01$322.58$322.58RVU24B
2024-03-09$322.58$322.58RVU24AR
2024-01-01$317.31$317.31RVU24A
2023-10-01$326.02$326.02RVU23D
2023-07-01$326.02$326.02RVU23C
2023-04-01$326.02$326.02RVU23B
2023-01-01$326.02$326.02RVU23A
2022-10-01$334.25$334.25RVU22D
2022-07-01$334.25$334.25RVU22C
2022-04-01$334.25$334.25RVU22B
2022-01-01$334.25$334.25RVU22A
2021-10-01$333.85$333.85RVU21D
2021-07-01$333.85$333.85RVU21C
2021-04-01$333.85$333.85RVU21B
2021-01-01$333.85$333.85RVU21A
2020-10-01$306.93$306.93RVU20D
2020-07-01$306.93$306.93RVU20C
2020-04-01$306.93$306.93RVU20B
2020-01-01$306.93$306.93RVU20A
2019-10-01$307.29$307.29RVU19D
2019-07-01$307.29$307.29RVU19C
2019-04-01$307.29$307.29RVU19B
2019-01-01$307.29$307.29RVU19A
2018-10-01$306.18$306.18RVU18D
2018-07-01$306.18$306.18RVU18C
2018-04-01$306.18$306.18RVU18B
2018-01-01$306.18$306.18RVU18AR1
2017-10-01$305.44$305.44RVU17D
2017-07-01$305.44$305.44RVU17C
2017-04-01$305.44$305.44RVU17B
2017-01-01$305.44$305.44RVU17A
2016-10-01$305.83$305.83RVU16D
2016-07-01$305.83$305.83RVU16C
2016-04-01$305.83$305.83RVU16B
2016-01-01$305.83$305.83RVU16A
2015-10-01$306.19$306.19RVU15D
2015-07-01$306.19$306.19RVU15C
2015-04-01$304.67$304.67RVU15B
2015-01-01$304.67$304.67RVU15A
2014-10-01$302.53$302.53RVU14D
2014-07-01$302.53$302.53RVU14C
2014-04-01$302.53$302.53RVU14B
2014-01-01$302.53$302.53RVU14A
2013-10-01$295.21$295.21RVU13D
2013-07-01$295.21$295.21RVU13C
2013-04-01$295.21$295.21RVU13B
2013-01-01$295.21$295.21RVU13AR

Price 90959 for an earlier date of service

Where the Delaware rate applies

Delaware is a Medicare payment area, not a city. Our Census mapping connects it to 79 cities and communities in Delaware. Some span more than one payment area; confirm with the service ZIP.

  • Arden
  • Ardencroft
  • Ardentown
  • Bear
  • Bellefonte
  • Bethany Beach
  • Bethel
  • Blades

Browse all communities in Delaware

90959 billing questions

When is 90959 chosen instead of 90958?

For a patient age 12 through 19, 90959 corresponds to one face-to-face visit during the month. Code 90958 is the sibling for two or three visits.

Does each dialysis treatment count as a visit for this code?

No. The code level is based on the number of face-to-face visits for monthly ESRD management, not the number of dialysis treatments performed.

Can 90959 be reported for each dialysis session?

No. It represents monthly ESRD-related management for the specified age and visit level, not a charge for each dialysis treatment.

What documentation supports reporting 90959?

Document the patient’s age, the date and substance of the face-to-face evaluation, and the ESRD-related management furnished during the month.

How does 90959 differ from the home dialysis monthly code?

90959 belongs to the monthly ESRD service series for the 12–19 age group and one face-to-face visit. Code 90965 is the corresponding monthly code for a home dialysis patient in that age group.

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 90959PPRRVU2026_Oct_nonQPP.csv, line 11,572 (RVU26D)
Geographic factors for DelawareGPCI2026.csv, line 40 (RVU26D)

Open CMS sourceHow we calculate rates

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