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

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 Virginia, Medicare pays $305.15 for 90961 in the office and $305.15 when it’s performed in a hospital or facility.

$305.15Office (non-facility)
$305.15Hospital or facility
−1.8%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 Virginia
  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 Virginia 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. Virginia pays $305.15. The RVUs are the same everywhere; the geographic indexes change the dollars.

90961 in Virginia vs other payment areas
  1. Virginia · this page$305.15
  2. Los Angeles, CA · California$335.05+$29.90
  3. Washington, DC area · District of Columbia$342.28+$37.13
  4. Miami, FL · Florida$333.70+$28.55
  5. Chicago, IL · Illinois$328.06+$22.91
  6. Manhattan, NY · New York$347.98+$42.83
  7. Alaska · Alaska$404.84+$99.69

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

Every other payment area

90961 in every other Medicare payment locality
Payment localityOfficeFacility
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
El Centro, CACalifornia$319.21$319.21
Fresno, CACalifornia$319.15$319.15
Hanford, 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 Virginia 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

106

Locality
Virginia
Physician work
1.000
Practice expense
0.983
Malpractice
0.706
Office calculation for 90961 in Virginia
ComponentRVULocality factorAdjusted
Physician work5.52× 1.0005.5200
Practice expense3.42× 0.9833.3619
Malpractice0.36× 0.7060.2542
Total RVUs9.1360
Conversion factor× 33.4009

Office rate, Virginia$305.15

Office: (5.52 × 1 + 3.42 × 0.983 + 0.36 × 0.706) × $33.4009 = $305.15

Facility: (5.52 × 1 + 3.42 × 0.983 + 0.36 × 0.706) × $33.4009 = $305.15

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, Virginia
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.$366.28
90962ESRD monthly care, one visit, age 20+Monthly ESRD management for patients age 20 or older with one face-to-face visit.$211.44
90958ESRD management, age 12-19, 2-3 visitsThe two-to-three-visit monthly level for patients ages 12 through 19.$509.86
Used instead
90966Home dialysis, monthly, age 20 and olderMonthly ESRD services for patients age 20 or older receiving home dialysis.$304.82
90970ESRD services, per day, age 20 or olderPer-day ESRD services for patients age 20 or older, rather than the monthly management level.$9.86

How 90961 has changed in Virginia

90961 · Office / nonfacility

$305.15

Effective 2026-10-01

The base rate is $24.36 higher than on 2025-10-01, moving from $280.79 to $305.15 (8.7%).

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

    $280.79changed to$305.15

    • 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 1.002 changed to 1.000
    • Practice expense GPCI 0.984 changed to 0.983
    • Malpractice GPCI 0.755 changed to 0.706

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $286.34changed to$280.79

    • 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

    $281.66changed to$286.34

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $290.51changed to$281.66

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.80 changed to 2.86
    • Work GPCI 1.000 changed to 1.002
    • Practice expense GPCI 0.990 changed to 0.984
    • Malpractice GPCI 0.826 changed to 0.755

  5. January 1, 2023

    RVU23A

    $297.99changed to$290.51

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense GPCI 0.995 changed to 0.990
    • Malpractice GPCI 0.897 changed to 0.826

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $298.41changed to$297.99

    • 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

    $243.04changed to$298.41

    • 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
    • Practice expense GPCI 0.991 changed to 0.995
    • Malpractice GPCI 0.903 changed to 0.897

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $240.95changed to$243.04

    • 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
    • Practice expense GPCI 0.986 changed to 0.991
    • Malpractice GPCI 0.908 changed to 0.903

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $240.69changed to$240.95

    • Conversion factor 35.9996 changed to 36.0391

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $238.78changed to$240.69

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.21 changed to 2.23
    • Practice expense GPCI 0.985 changed to 0.986
    • Malpractice GPCI 0.866 changed to 0.908

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $238.39changed to$238.78

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 2.23 changed to 2.21
    • Practice expense GPCI 0.983 changed to 0.985
    • Malpractice GPCI 0.824 changed to 0.866

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $239.19changed to$238.39

    • 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

    $238.00changed to$239.19

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $237.86changed to$238.00

    • 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
    • Practice expense GPCI 0.980 changed to 0.983
    • Malpractice GPCI 0.778 changed to 0.824

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $233.18changed to$237.86

    • 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
    • Practice expense GPCI 0.977 changed to 0.980
    • Malpractice GPCI 0.731 changed to 0.778

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $233.18

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$305.15$305.15RVU26D
2026-07-01$305.15$305.15RVU26C
2026-04-01$305.15$305.15RVU26B
2026-01-01$305.15$305.15RVU26A
2025-10-01$280.79$280.79RVU25D
2025-07-01$280.79$280.79RVU25C
2025-04-01$280.79$280.79RVU25B
2025-01-01$280.79$280.79RVU25A
2024-10-01$286.34$286.34RVU24D
2024-07-01$286.34$286.34RVU24C
2024-04-01$286.34$286.34RVU24B
2024-03-09$286.34$286.34RVU24AR
2024-01-01$281.66$281.66RVU24A
2023-10-01$290.51$290.51RVU23D
2023-07-01$290.51$290.51RVU23C
2023-04-01$290.51$290.51RVU23B
2023-01-01$290.51$290.51RVU23A
2022-10-01$297.99$297.99RVU22D
2022-07-01$297.99$297.99RVU22C
2022-04-01$297.99$297.99RVU22B
2022-01-01$297.99$297.99RVU22A
2021-10-01$298.41$298.41RVU21D
2021-07-01$298.41$298.41RVU21C
2021-04-01$298.41$298.41RVU21B
2021-01-01$298.41$298.41RVU21A
2020-10-01$243.04$243.04RVU20D
2020-07-01$243.04$243.04RVU20C
2020-04-01$243.04$243.04RVU20B
2020-01-01$243.04$243.04RVU20A
2019-10-01$240.95$240.95RVU19D
2019-07-01$240.95$240.95RVU19C
2019-04-01$240.95$240.95RVU19B
2019-01-01$240.95$240.95RVU19A
2018-10-01$240.69$240.69RVU18D
2018-07-01$240.69$240.69RVU18C
2018-04-01$240.69$240.69RVU18B
2018-01-01$240.69$240.69RVU18AR1
2017-10-01$238.78$238.78RVU17D
2017-07-01$238.78$238.78RVU17C
2017-04-01$238.78$238.78RVU17B
2017-01-01$238.78$238.78RVU17A
2016-10-01$238.39$238.39RVU16D
2016-07-01$238.39$238.39RVU16C
2016-04-01$238.39$238.39RVU16B
2016-01-01$238.39$238.39RVU16A
2015-10-01$239.19$239.19RVU15D
2015-07-01$239.19$239.19RVU15C
2015-04-01$238.00$238.00RVU15B
2015-01-01$238.00$238.00RVU15A
2014-10-01$237.86$237.86RVU14D
2014-07-01$237.86$237.86RVU14C
2014-04-01$237.86$237.86RVU14B
2014-01-01$237.86$237.86RVU14A
2013-10-01$233.18$233.18RVU13D
2013-07-01$233.18$233.18RVU13C
2013-04-01$233.18$233.18RVU13B
2013-01-01$233.18$233.18RVU13AR

Price 90961 for an earlier date of service

Where the Virginia rate applies

Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Abbs Valley
  • Abingdon
  • Accomac
  • Adwolf
  • Afton
  • Alberta
  • Aldie
  • Allison Gap

Browse all communities in Virginia

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 VirginiaGPCI2026.csv, line 106 (RVU26D)

Open CMS sourceHow we calculate rates

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