CPT code 90960: Monthly ESRD services, age 20+, four or more visits2026 Medicare rate & RVUs in Georgia
Report monthly ESRD management for a facility-based dialysis patient age 20 or older when qualified practitioners furnish at least four face-to-face visits.
Medicare pays $361.23–$378.44 for 90960 in the office in Georgia, from Rest of Georgia to Atlanta, GA. 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 90960 covers
This service covers a full calendar month of professional ESRD management for a patient age 20 or older receiving facility-based dialysis, commonly in-center hemodialysis. A nephrologist or qualified nonphysician practitioner typically reviews dialysis adequacy, laboratory results, anemia treatment, bone-mineral management, fluid status, blood pressure, and vascular access concerns. Face-to-face visits commonly occur at the dialysis facility, with care coordinated with its staff.
Report one unit for the month when at least four qualifying face-to-face visits are documented; the visits do not generate four monthly units. Record each visit's date, practitioner, and ESRD-related assessment or management. Use 90961 or 90962 for a full month with fewer visits, and 90966 for monthly home dialysis management in this age group. For a partial month, such as dialysis initiation or a transplant during the month, consider the age-appropriate per-day ESRD code. Hospitalization alone does not make a month partial. The monthly professional service includes management of ESRD-related problems; dialysis facility services are distinct.
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 90960 pays more and less in Georgia
| Payment locality | Office | Facility |
|---|---|---|
| Atlanta, GA | $378.44 | $378.44 |
| Rest of Georgia | $361.23 | $361.23 |
How the 90960 rate is calculated
Each of 90960’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 · 90960
RVUs × geographic indexes × conversion factor
Work6.77
6.77 RVUs× 1.000 GPCI
Practice expense3.96
3.96 RVUs× 1.000 GPCI
Malpractice0.43
0.43 RVUs× 1.000 GPCI
Adjusted RVUs
11.1600
Conversion factor
$33.4009
Medicare rate
$372.75
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 90960
90960 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 · 90960
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$372.75
- Non-facility (office)
- $372.75
- Facility
- $372.75
Higher because the practice carries its own overhead.
90960 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 90961ESRD management2-3 visits, age 20+
- Both describe a full month of facility-based ESRD management for patients age 20 or older. Use 90960 for at least four qualifying visits and 90961 for two or three.
- 90966Home dialysisMonthly, age 20 and older
- 90966 describes monthly ESRD management for a patient age 20 or older on home dialysis. Use 90960 for facility-based dialysis when at least four qualifying visits are furnished.
- 90970ESRD servicesPer day, age 20 or older
- 90970 describes per-day ESRD management for a patient age 20 or older during a partial month. 90960 describes a full month with at least four qualifying visits.
- 90935HemodialysisOne clinician evaluation
- 90935 describes a hemodialysis procedure with one evaluation, such as during a hospital stay. 90960 describes monthly professional ESRD management, not an individual dialysis session.
90960 billing questions
How do I choose between 90960, 90961, and 90962?
Count qualifying face-to-face ESRD visits during the calendar month for a patient age 20 or older. Four or more supports 90960, two or three supports 90961, and one supports 90962.
How many units are reported when the patient has four or more visits?
Report one unit of 90960 for the full calendar month of professional ESRD management, rather than one unit for each visit.
Does 90960 describe each hemodialysis session?
No. It describes monthly professional management; 90935 describes a hemodialysis procedure with one evaluation when a procedure code is appropriate, such as during a hospital stay.
What should I report when the patient receives dialysis for only part of the month?
For partial-month management, such as dialysis beginning mid-month or ending after transplant or death, the age-appropriate per-day ESRD code is generally used; 90970 is the code for patients age 20 or older. Hospitalization during the month does not by itself require per-day billing.
Are office E/M visits for kidney-related problems separately billable during the month?
ESRD-related management is included in the monthly service. An office E/M service for an unrelated condition must be distinct from the dialysis management to be separately reported.
What documentation supports the four-visit threshold?
Identify the date and qualified practitioner for each face-to-face ESRD visit and document the assessment or management furnished. A laboratory review without a face-to-face visit does not add to the visit count.
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
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