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CPT code 90961: ESRD management, 2-3 visits, age 20+2026 Medicare rate & RVUs in Manhattan, NY

Monthly ESRD management for patients age 20 or older, reported when the physician provides two or three face-to-face visits during the month.

CMS RVU26DEffective Oct 1, 2026One payment locality393K Medicare services in 2024

In Manhattan, NY, Medicare pays $347.98 for 90961 in the office and $347.98 when it’s performed in a hospital or facility.

$347.98Office (non-facility)
$347.98Hospital or facility
+12.0%vs the national office rate ($310.63)

Check a contract rate as a % of Medicare · 90961 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 90961 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Manhattan, NY
  2. What 90961 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 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.

How Manhattan, NY compares for 90961

Across 109 of 109 payment localities, the office rate for 90961 runs from $288.69 in Arkansas to $404.84 in Alaska. Manhattan, NY pays $347.98. The RVUs are the same everywhere; the geographic indexes change the dollars.

90961 in Manhattan, NY vs other payment areas
  1. Manhattan, NY · this page$347.98
  2. NYC suburbs and Long Island, NY · New York$354.32+$6.34
  3. Poughkeepsie and northern NYC suburbs, NY · New York$332.30−$15.68
  4. Queens, NY · New York$348.53+$0.55
  5. Rest of New York · New York$301.35−$46.63
  6. Los Angeles, CA · California$335.05−$12.93
  7. Washington, DC area · District of Columbia$342.28−$5.70

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

Every other payment area

90961 in every other Medicare payment locality
Payment localityOfficeFacility
Miami, FLFlorida$333.70$333.70
Chicago, ILIllinois$328.06$328.06
AlaskaAlaska$404.84$404.84
AlabamaAlabama$291.13$291.13
ArkansasArkansas$288.69$288.69
ArizonaArizona$305.36$305.36
Bakersfield, CACalifornia$320.40$320.40
Chico, CACalifornia$319.15$319.15

90961 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.

$288.69

$404.84

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

View every state and territory as a table
90961 office rate range by state
State / territoryOffice rate rangeLocalities
AK$404.841
AL$291.131
AR$288.691
AZ$305.361
CA$319.15–$375.8229
CO$317.521
CT$325.641
DC$342.281
DE$308.971
FL$311.65–$333.703
GA$300.60–$315.432
GU$321.221
HI$321.221
IA$293.671
ID$295.151
IL$307.46–$328.064
IN$296.111
KS$293.701
KY$296.931
LA$296.99–$305.522
MA$317.19–$339.032
MD$312.86–$342.283
ME$296.94–$305.162
MI$302.24–$314.882
MN$305.481
MO$294.55–$305.173
MS$291.611
MT$310.601
NC$298.631
ND$303.491
NE$294.351
NH$313.811
NJ$329.68–$341.342
NM$303.561
NV$308.731
NY$301.35–$354.325
OH$300.791
OK$295.721
OR$306.60–$323.182
PA$300.60–$320.952
PR$311.701
RI$316.601
SC$300.141
SD$302.641
TN$294.671
TX$299.49–$316.258
UT$302.551
VA$305.15–$342.282
VI$311.701
VT$303.551
WA$316.21–$343.582
WI$297.511
WV$300.851
WY$307.501

See 90961 in every payment locality

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

Office or facility?

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.

The exact Manhattan, NY inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

11,574

Code
90961
Physician work
5.52
Practice expense
3.42
Malpractice
0.36

GPCI2026.csv

78

Locality
Manhattan, NY
Physician work
1.064
Practice expense
1.162
Malpractice
1.586
Office calculation for 90961 in Manhattan, NY
ComponentRVULocality factorAdjusted
Physician work5.52× 1.0645.8733
Practice expense3.42× 1.1623.9740
Malpractice0.36× 1.5860.5710
Total RVUs10.4183
Conversion factor× 33.4009

Office rate, Manhattan, NY$347.98

Office: (5.52 × 1.064 + 3.42 × 1.162 + 0.36 × 1.586) × $33.4009 = $347.98

Facility: (5.52 × 1.064 + 3.42 × 1.162 + 0.36 × 1.586) × $33.4009 = $347.98

Open 90961 in the RVU calculator

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.

Codes related to 90961

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

Codes related to 90961
CodeHow it relatesOffice range, Manhattan, NY
Same family
90960Monthly ESRD services, age 20+, four or more visitsMonthly ESRD management for patients age 20 or older with four or more face-to-face visits.$417.07
90962ESRD monthly care, one visit, age 20+Monthly ESRD management for patients age 20 or older with one face-to-face visit.$241.38
90958ESRD management, age 12-19, 2-3 visitsThe two-to-three-visit monthly level for patients ages 12 through 19.$579.08
Used instead
90966Home dialysis, monthly, age 20 and olderMonthly ESRD services for patients age 20 or older receiving home dialysis.$347.59
90970ESRD services, per day, age 20 or olderPer-day ESRD services for patients age 20 or older, rather than the monthly management level.$11.20

How 90961 has changed in Manhattan, NY

90961 · Office / nonfacility

$347.98

Effective 2026-10-01

The base rate is $28.72 higher than on 2025-10-01, moving from $319.26 to $347.98 (9.0%).

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

    $319.26changed to$347.98

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 2.94 changed to 3.42
    • Malpractice RVU 0.34 changed to 0.36
    • Work GPCI 1.065 changed to 1.064
    • Practice expense GPCI 1.166 changed to 1.162
    • Malpractice GPCI 1.656 changed to 1.586

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $325.44changed to$319.26

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 2.86 changed to 2.94

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $320.13changed to$325.44

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $332.05changed to$320.13

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.80 changed to 2.86
    • Work GPCI 1.061 changed to 1.065
    • Practice expense GPCI 1.184 changed to 1.166
    • Malpractice GPCI 1.843 changed to 1.656

  5. January 1, 2023

    RVU23A

    $342.19changed to$332.05

    • Conversion factor 34.6062 changed to 33.8872
    • Work GPCI 1.056 changed to 1.061
    • Practice expense GPCI 1.203 changed to 1.184
    • Malpractice GPCI 2.031 changed to 1.843

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $342.22changed to$342.19

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 2.75 changed to 2.80
    • Malpractice RVU 0.33 changed to 0.34

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $276.37changed to$342.22

    • Conversion factor 36.0896 changed to 34.8931
    • Work RVU 4.26 changed to 5.52
    • Practice expense RVU 2.26 changed to 2.75
    • Malpractice RVU 0.26 changed to 0.33
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.192 changed to 1.203
    • Malpractice GPCI 1.823 changed to 2.031

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $270.89changed to$276.37

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 2.23 changed to 2.26
    • Malpractice RVU 0.25 changed to 0.26
    • Work GPCI 1.052 changed to 1.054
    • Practice expense GPCI 1.180 changed to 1.192
    • Malpractice GPCI 1.615 changed to 1.823

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $270.60changed to$270.89

    • Conversion factor 35.9996 changed to 36.0391

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $269.11changed to$270.60

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.21 changed to 2.23
    • Practice expense GPCI 1.174 changed to 1.180
    • Malpractice GPCI 1.690 changed to 1.615

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $269.50changed to$269.11

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 2.23 changed to 2.21
    • Practice expense GPCI 1.168 changed to 1.174
    • Malpractice GPCI 1.764 changed to 1.690

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $270.69changed to$269.50

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 2.22 changed to 2.23
    • Malpractice RVU 0.26 changed to 0.25

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $269.34changed to$270.69

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $267.96changed to$269.34

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 2.23 changed to 2.22
    • Malpractice RVU 0.25 changed to 0.26
    • Work GPCI 1.057 changed to 1.052
    • Practice expense GPCI 1.165 changed to 1.168
    • Malpractice GPCI 1.518 changed to 1.764

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $262.42changed to$267.96

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.46 changed to 2.23
    • Malpractice RVU 0.26 changed to 0.25
    • Work GPCI 1.062 changed to 1.057
    • Practice expense GPCI 1.162 changed to 1.165
    • Malpractice GPCI 1.271 changed to 1.518

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $262.42

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$347.98$347.98RVU26D
2026-07-01$347.98$347.98RVU26C
2026-04-01$347.98$347.98RVU26B
2026-01-01$347.98$347.98RVU26A
2025-10-01$319.26$319.26RVU25D
2025-07-01$319.26$319.26RVU25C
2025-04-01$319.26$319.26RVU25B
2025-01-01$319.26$319.26RVU25A
2024-10-01$325.44$325.44RVU24D
2024-07-01$325.44$325.44RVU24C
2024-04-01$325.44$325.44RVU24B
2024-03-09$325.44$325.44RVU24AR
2024-01-01$320.13$320.13RVU24A
2023-10-01$332.05$332.05RVU23D
2023-07-01$332.05$332.05RVU23C
2023-04-01$332.05$332.05RVU23B
2023-01-01$332.05$332.05RVU23A
2022-10-01$342.19$342.19RVU22D
2022-07-01$342.19$342.19RVU22C
2022-04-01$342.19$342.19RVU22B
2022-01-01$342.19$342.19RVU22A
2021-10-01$342.22$342.22RVU21D
2021-07-01$342.22$342.22RVU21C
2021-04-01$342.22$342.22RVU21B
2021-01-01$342.22$342.22RVU21A
2020-10-01$276.37$276.37RVU20D
2020-07-01$276.37$276.37RVU20C
2020-04-01$276.37$276.37RVU20B
2020-01-01$276.37$276.37RVU20A
2019-10-01$270.89$270.89RVU19D
2019-07-01$270.89$270.89RVU19C
2019-04-01$270.89$270.89RVU19B
2019-01-01$270.89$270.89RVU19A
2018-10-01$270.60$270.60RVU18D
2018-07-01$270.60$270.60RVU18C
2018-04-01$270.60$270.60RVU18B
2018-01-01$270.60$270.60RVU18AR1
2017-10-01$269.11$269.11RVU17D
2017-07-01$269.11$269.11RVU17C
2017-04-01$269.11$269.11RVU17B
2017-01-01$269.11$269.11RVU17A
2016-10-01$269.50$269.50RVU16D
2016-07-01$269.50$269.50RVU16C
2016-04-01$269.50$269.50RVU16B
2016-01-01$269.50$269.50RVU16A
2015-10-01$270.69$270.69RVU15D
2015-07-01$270.69$270.69RVU15C
2015-04-01$269.34$269.34RVU15B
2015-01-01$269.34$269.34RVU15A
2014-10-01$267.96$267.96RVU14D
2014-07-01$267.96$267.96RVU14C
2014-04-01$267.96$267.96RVU14B
2014-01-01$267.96$267.96RVU14A
2013-10-01$262.42$262.42RVU13D
2013-07-01$262.42$262.42RVU13C
2013-04-01$262.42$262.42RVU13B
2013-01-01$262.42$262.42RVU13AR

Price 90961 for an earlier date of service

Where the Manhattan, NY rate applies

Manhattan, NY is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in New York. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in New York

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

Show the CMS file lines behind this rate
RVUs for 90961PPRRVU2026_Oct_nonQPP.csv, line 11,574 (RVU26D)
Geographic factors for Manhattan, NYGPCI2026.csv, line 78 (RVU26D)

Open CMS sourceHow we calculate rates

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