CPT code 90959: ESRD monthly care, age 12–19, one visit2026 Medicare rate & RVUs in Missouri
Monthly ESRD-related management for a patient age 12 through 19 when one face-to-face visit is provided during the month.
Medicare pays $322.23–$333.32 for 90959 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. 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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On this page 9 sections
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 in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$322.23 to $333.32
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $331.45 | $331.45 |
| Metropolitan St. Louis, MO | $333.32 | $333.32 |
| Rest of Missouri | $322.23 | $322.23 |
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
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.
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.
90959 compared with similar codes
Compare codes · National
5 codes, side by side
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.
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
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