CPT code 90962: ESRD monthly care, one visit, age 20+2026 Medicare rate & RVUs in Maryland
Monthly ESRD-related management for a patient age 20 or older receiving facility-based dialysis when the physician or qualified professional makes one visit that month.
Medicare pays $216.75–$238.13 for 90962 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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What 90962 covers
This code represents monthly management of end-stage renal disease for an adult receiving dialysis outside the home-dialysis monthly service series. A nephrologist or other qualified health care professional typically evaluates the patient and manages ESRD-related concerns such as dialysis adequacy, vascular access, fluid status, anemia, medication needs, and complications. Care may involve coordination with the dialysis facility and the patient’s broader treatment team.
Report one unit for the calendar month when the patient is age 20 or older and the service meets the one-visit level. Select the monthly code using the patient’s age, dialysis setting or modality, and number of qualifying visits during the month; this code is distinct from levels for two or three visits and four or more visits. Documentation should support the visit and the monthly ESRD management provided. It represents monthly care, not a separate charge for each dialysis session.
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 90962 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
$216.75 to $238.13
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | $225.21 | $225.21 |
| Rest of Maryland | $216.75 | $216.75 |
| Washington, DC area | $238.13 | $238.13 |
How the 90962 rate is calculated
Each of 90962’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 · 90962
RVUs × geographic indexes × conversion factor
Work3.57
3.57 RVUs× 1.000 GPCI
Practice expense2.65
2.65 RVUs× 1.000 GPCI
Malpractice0.22
0.22 RVUs× 1.000 GPCI
Adjusted RVUs
6.4400
Conversion factor
$33.4009
Medicare rate
$215.10
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 90962
90962 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 · 90962
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$215.10
- Non-facility (office)
- $215.10
- Facility
- $215.10
Higher because the practice carries its own overhead.
90962 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 90960Monthly ESRD servicesAge 20+, four or more visits
- Both describe monthly ESRD management for patients age 20 or older in the non-home monthly series. Use 90960 when the month includes four or more qualifying visits rather than one.
- 90961ESRD management2-3 visits, age 20+
- 90961 is the two-to-three-visit monthly level for patients age 20 or older; 90962 is the one-visit level.
- 90966Home dialysisMonthly, age 20 and older
- 90966 is the monthly service code for a patient age 20 or older receiving home dialysis. 90962 belongs to the non-home monthly series.
- 90970ESRD servicesPer day, age 20 or older
- 90970 reports ESRD services by day for a patient age 20 or older when care covers only part of a month; 90962 is the one-visit monthly level.
90962 billing questions
When is 90962 selected instead of 90961 or 90960?
Use 90962 for an eligible patient age 20 or older when there is one qualifying visit in the month. The other codes in this group correspond to two or three visits, or four or more visits.
Does 90962 represent each dialysis treatment?
No. It represents the monthly ESRD-related management level, not a per-session service. Do not count each dialysis treatment as a separate unit of 90962.
Can 90962 be used for a patient receiving home dialysis?
The home-dialysis monthly series has separate codes, including 90966 for patients age 20 or older. Choose the code that matches the patient’s dialysis setting and monthly circumstances.
What documentation supports the one-visit level?
Document the date and substance of the qualifying visit, the patient’s ESRD-related assessment and management, and the care coordination performed. The record should also support the patient’s age and dialysis circumstances.
What if monthly ESRD care covers only part of the month?
The per-day ESRD service series may be relevant when care is provided for only part of a month. For a patient age 20 or older, compare the circumstances with 90970.
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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