CPT code 90961: ESRD management, 2-3 visits, age 20+2026 Medicare rate & RVUs in Maryland
Monthly ESRD management for patients age 20 or older, reported when the physician provides two or three face-to-face visits during the month.
Medicare pays $312.86–$342.28 for 90961 in the office in Maryland, from Rest of Maryland to Washington, DC area. 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 90961 covers
This code represents a month of ongoing management for an adult with end-stage renal disease receiving dialysis. A nephrologist or other physician overseeing the patient’s ESRD care may assess dialysis adequacy, fluid status, anemia, mineral and bone disease, medications, vascular access, and related treatment needs. The work may occur in the context of outpatient dialysis care and includes the physician’s continuing management across the month, not just a single dialysis treatment.
Select this monthly level for a patient age 20 or older when the physician provides two or three face-to-face visits during the month. The visit count, dates, age, and documented ESRD management support the level reported. Do not count dialysis sessions as physician visits. The adjacent monthly levels distinguish patients with four or more visits from those with one visit; separate home-dialysis and per-day codes describe different circumstances.
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 90961 pays more and less in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$312.86 to $342.28
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | $324.77 | $324.77 |
| Rest of Maryland | $312.86 | $312.86 |
| Washington, DC area | $342.28 | $342.28 |
How the 90961 rate is calculated
Each of 90961’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 · 90961
RVUs × geographic indexes × conversion factor
Work5.52
5.52 RVUs× 1.000 GPCI
Practice expense3.42
3.42 RVUs× 1.000 GPCI
Malpractice0.36
0.36 RVUs× 1.000 GPCI
Adjusted RVUs
9.3000
Conversion factor
$33.4009
Medicare rate
$310.63
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 90961
90961 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 · 90961
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$310.63
- Non-facility (office)
- $310.63
- Facility
- $310.63
Higher because the practice carries its own overhead.
90961 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 90960Monthly ESRD servicesAge 20+, four or more visits
- Both are monthly ESRD management codes for patients age 20 or older. Choose 90960 when the month includes four or more face-to-face visits; 90961 is for two or three.
- 90962ESRD monthly careOne visit, age 20+
- 90962 is the one-visit monthly level for patients age 20 or older. 90961 requires two or three face-to-face visits during the month.
- 90966Home dialysisMonthly, age 20 and older
- 90966 describes monthly ESRD services for an adult receiving home dialysis. 90961 uses the two-to-three-visit monthly level for its patient category.
- 90970ESRD servicesPer day, age 20 or older
- 90970 reports ESRD services per day for patients age 20 or older; 90961 represents monthly management when two or three face-to-face visits occur.
90961 billing questions
How does 90961 differ from 90960 and 90962?
For patients age 20 or older, 90961 represents two or three face-to-face visits in the month. Use 90960 for four or more visits and 90962 for one visit.
Are dialysis sessions counted as visits?
No. The level is based on the physician’s face-to-face visits with the patient during the month, not the number of dialysis treatments.
What documentation supports reporting 90961?
Record the patient’s age, the dates of the two or three face-to-face visits, and the ESRD management addressed during the month.
Is 90961 reported once per visit?
No. It represents monthly ESRD management at the two-to-three-visit level, rather than a separate unit for each visit.
How does 90961 differ from 90966?
90961 is selected by the monthly face-to-face visit count for an adult patient. 90966 describes monthly ESRD services for an adult receiving home dialysis.
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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