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CPT code 90963: ESRD management, home dialysis, under age 22026 Medicare rate & RVUs in North Carolina

Monthly ESRD-related management for a child younger than 2 years receiving home dialysis, reported for the applicable month of care.

CMS RVU26DEffective Oct 1, 2026One payment locality108 Medicare services in 2024

In North Carolina, Medicare pays $604.00 for 90963 in the office and $604.00 when it’s performed in a hospital or facility.

$604.00Office (non-facility)
$604.00Hospital or facility
−3.6%vs the national office rate ($626.27)

Check a contract rate as a % of Medicare · 90963 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 90963 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Carolina
  2. What 90963 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 90963 covers

Code 90963 covers a physician’s month-level management of a child younger than 2 years who receives dialysis at home. The nephrologist or other clinician managing the renal replacement plan assesses the child’s clinical course, dialysis prescription, fluid balance, blood pressure, laboratory findings, medications, nutrition, growth, and dialysis access, and adjusts care as needed. This work commonly occurs through a pediatric nephrology practice, with coordination among caregivers, home dialysis nurses, and the dialysis program.

Select this code based on the home-dialysis setting, the patient’s age, and the billing period. It represents monthly ESRD-related management, rather than a dialysis treatment session. Dated documentation should support the clinician’s assessment and management during the month. When ESRD-related services are furnished for less than a full month, the age-specific per-day code 90967 is the related reporting option. CMS PFS pricing assigns work, practice-expense, and malpractice RVUs to this monthly service.

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 North Carolina compares for 90963

Across 109 of 109 payment localities, the office rate for 90963 runs from $586.28 in Arkansas to $829.76 in Alaska. North Carolina pays $604.00. The RVUs are the same everywhere; the geographic indexes change the dollars.

90963 in North Carolina vs other payment areas
  1. North Carolina · this page$604.00
  2. Los Angeles, CA · California$670.53+$66.53
  3. Washington, DC area · District of Columbia$686.04+$82.04
  4. Miami, FL · Florida$672.66+$68.66
  5. Chicago, IL · Illinois$662.52+$58.52
  6. Manhattan, NY · New York$698.77+$94.77
  7. Alaska · Alaska$829.76+$225.76

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

Every other payment area

90963 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$590.72$590.72
ArkansasArkansas$586.28$586.28
ArizonaArizona$616.54$616.54
Bakersfield, CACalifornia$643.09$643.09
Chico, CACalifornia$640.46$640.46
El Centro, CACalifornia$640.58$640.58
Fresno, CACalifornia$640.46$640.46
Hanford, CACalifornia$640.46$640.46

90963 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.

$586.28

$829.76

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

View every state and territory as a table
90963 office rate range by state
State / territoryOffice rate rangeLocalities
AK$829.761
AL$590.721
AR$586.281
AZ$616.541
CA$640.46–$746.3129
CO$638.261
CT$654.801
DC$686.041
DE$623.391
FL$630.18–$672.663
GA$609.76–$635.672
GU$642.761
HI$642.761
IA$594.381
ID$597.271
IL$623.20–$662.524
IN$598.981
KS$594.891
KY$602.231
LA$602.51–$618.032
MA$638.10–$678.362
MD$630.62–$686.043
ME$601.01–$615.252
MI$612.32–$636.542
MN$614.361
MO$598.37–$616.843
MS$592.291
MT$626.221
NC$604.001
ND$611.391
NE$595.491
NH$631.231
NJ$663.01–$684.992
NM$614.921
NV$622.281
NY$608.96–$710.895
OH$609.291
OK$599.561
OR$618.04–$648.232
PA$608.70–$646.462
PR$628.061
RI$637.751
SC$607.511
SD$609.631
TN$596.711
TX$606.72–$637.538
UT$611.871
VA$615.55–$686.042
VI$628.061
VT$611.921
WA$635.99–$686.682
WI$600.641
WV$611.201
WY$619.751

See 90963 in every payment locality

How the 90963 rate is calculated

Each of 90963’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 · 90963

RVUs × geographic indexes × conversion factor

Office or facility?

Work12.09

12.09 RVUs× 1.000 GPCI

Practice expense5.91

5.91 RVUs× 1.000 GPCI

Malpractice0.75

0.75 RVUs× 1.000 GPCI

Adjusted RVUs

18.7500

Conversion factor

$33.4009

Medicare rate

$626.27

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact North Carolina inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

11,576

Code
90963
Physician work
12.09
Practice expense
5.91
Malpractice
0.75

GPCI2026.csv

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 90963 in North Carolina
ComponentRVULocality factorAdjusted
Physician work12.09× 1.00012.0900
Practice expense5.91× 0.9335.5140
Malpractice0.75× 0.6390.4793
Total RVUs18.0833
Conversion factor× 33.4009

Office rate, North Carolina$604.00

Office: (12.09 × 1 + 5.91 × 0.933 + 0.75 × 0.639) × $33.4009 = $604.00

Facility: (12.09 × 1 + 5.91 × 0.933 + 0.75 × 0.639) × $33.4009 = $604.00

Open 90963 in the RVU calculator

Payment rules and modifiers for 90963

90963 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 · 90963

Which rate does Medicare pay?

The POS code on the claim line (CMS-1500 box 24B).

POS 11 · non-facility rate · national

$626.27

Non-facility (office)
$626.27
Facility
$626.27

Higher because the practice carries its own overhead.

Codes related to 90963

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

Codes related to 90963
CodeHow it relatesOffice range, North Carolina
Same family
90964ESRD services, home dialysis, ages 2–11Monthly home-dialysis ESRD management for patients ages 2 through 11.$515.15
90965Home dialysis, ages 12 through 19Monthly home-dialysis ESRD management for patients ages 12 through 19.$497.51
90966Home dialysis, monthly, age 20 and olderMonthly home-dialysis ESRD management for patients age 20 or older.$298.32
Used instead
90967ESRD services, patient younger than 2Per-day ESRD-related services for a home-dialysis patient younger than 2 when care covers less than a full month.$17.73
90951ESRD monthly care, under 2 years, 4+ visitsIn-center monthly ESRD management for a patient younger than 2 at the four-or-more-visit level.$1,143.61

How 90963 has changed in North Carolina

90963 · Office / nonfacility

$604.00

Effective 2026-10-01

The base rate is $42.11 higher than on 2025-10-01, moving from $561.89 to $604.00 (7.5%).

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

    $561.89changed to$604.00

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 5.15 changed to 5.91
    • Malpractice RVU 0.77 changed to 0.75
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.665 changed to 0.639

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $577.93changed to$561.89

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 5.14 changed to 5.15

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $568.49changed to$577.93

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $587.51changed to$568.49

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 5.06 changed to 5.14
    • Malpractice RVU 0.75 changed to 0.77
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665

  5. January 1, 2023

    RVU23A

    $602.71changed to$587.51

    • Conversion factor 34.6062 changed to 33.8872
    • Malpractice RVU 0.77 changed to 0.75
    • Practice expense GPCI 0.928 changed to 0.927
    • Malpractice GPCI 0.819 changed to 0.742

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $602.64changed to$602.71

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 4.93 changed to 5.06
    • Malpractice RVU 0.74 changed to 0.77

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $541.57changed to$602.64

    • Conversion factor 36.0896 changed to 34.8931
    • Work RVU 10.56 changed to 12.09
    • Practice expense RVU 4.26 changed to 4.93
    • Malpractice RVU 0.64 changed to 0.74
    • Practice expense GPCI 0.930 changed to 0.928
    • Malpractice GPCI 0.757 changed to 0.819

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $538.61changed to$541.57

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 4.24 changed to 4.26
    • Malpractice RVU 0.63 changed to 0.64
    • Practice expense GPCI 0.931 changed to 0.930
    • Malpractice GPCI 0.695 changed to 0.757

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $538.02changed to$538.61

    • Conversion factor 35.9996 changed to 36.0391

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $535.53changed to$538.02

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.19 changed to 4.24
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $534.60changed to$535.53

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.18 changed to 4.19
    • Practice expense GPCI 0.930 changed to 0.931
    • Malpractice GPCI 0.768 changed to 0.732

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $537.20changed to$534.60

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 4.20 changed to 4.18

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $534.53changed to$537.20

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $535.34changed to$534.53

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.27 changed to 4.20
    • Malpractice RVU 0.57 changed to 0.63
    • Practice expense GPCI 0.929 changed to 0.930
    • Malpractice GPCI 0.732 changed to 0.768

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $519.50changed to$535.34

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 4.63 changed to 4.27
    • Malpractice RVU 0.60 changed to 0.57
    • Practice expense GPCI 0.927 changed to 0.929
    • Malpractice GPCI 0.695 changed to 0.732

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $519.50

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$604.00$604.00RVU26D
2026-07-01$604.00$604.00RVU26C
2026-04-01$604.00$604.00RVU26B
2026-01-01$604.00$604.00RVU26A
2025-10-01$561.89$561.89RVU25D
2025-07-01$561.89$561.89RVU25C
2025-04-01$561.89$561.89RVU25B
2025-01-01$561.89$561.89RVU25A
2024-10-01$577.93$577.93RVU24D
2024-07-01$577.93$577.93RVU24C
2024-04-01$577.93$577.93RVU24B
2024-03-09$577.93$577.93RVU24AR
2024-01-01$568.49$568.49RVU24A
2023-10-01$587.51$587.51RVU23D
2023-07-01$587.51$587.51RVU23C
2023-04-01$587.51$587.51RVU23B
2023-01-01$587.51$587.51RVU23A
2022-10-01$602.71$602.71RVU22D
2022-07-01$602.71$602.71RVU22C
2022-04-01$602.71$602.71RVU22B
2022-01-01$602.71$602.71RVU22A
2021-10-01$602.64$602.64RVU21D
2021-07-01$602.64$602.64RVU21C
2021-04-01$602.64$602.64RVU21B
2021-01-01$602.64$602.64RVU21A
2020-10-01$541.57$541.57RVU20D
2020-07-01$541.57$541.57RVU20C
2020-04-01$541.57$541.57RVU20B
2020-01-01$541.57$541.57RVU20A
2019-10-01$538.61$538.61RVU19D
2019-07-01$538.61$538.61RVU19C
2019-04-01$538.61$538.61RVU19B
2019-01-01$538.61$538.61RVU19A
2018-10-01$538.02$538.02RVU18D
2018-07-01$538.02$538.02RVU18C
2018-04-01$538.02$538.02RVU18B
2018-01-01$538.02$538.02RVU18AR1
2017-10-01$535.53$535.53RVU17D
2017-07-01$535.53$535.53RVU17C
2017-04-01$535.53$535.53RVU17B
2017-01-01$535.53$535.53RVU17A
2016-10-01$534.60$534.60RVU16D
2016-07-01$534.60$534.60RVU16C
2016-04-01$534.60$534.60RVU16B
2016-01-01$534.60$534.60RVU16A
2015-10-01$537.20$536.87RVU15D
2015-07-01$537.20$536.87RVU15C
2015-04-01$534.53$534.19RVU15B
2015-01-01$534.53$534.19RVU15A
2014-10-01$535.34$535.34RVU14D
2014-07-01$535.34$535.34RVU14C
2014-04-01$535.34$535.34RVU14B
2014-01-01$535.34$535.34RVU14A
2013-10-01$519.50$519.50RVU13D
2013-07-01$519.50$519.50RVU13C
2013-04-01$519.50$519.50RVU13B
2013-01-01$519.50$519.50RVU13AR

Price 90963 for an earlier date of service

Where the North Carolina rate applies

North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Advance
  • Ahoskie
  • Alamance
  • Albemarle
  • Alexis
  • Alliance
  • Altamahaw

Browse all communities in North Carolina

90963 billing questions

Which patients qualify for 90963?

Use it for monthly ESRD-related services for a patient younger than 2 years who receives dialysis at home. The age and dialysis setting distinguish it from the other monthly ESRD management codes.

Is 90963 selected by the number of monthly visits?

No visit-count tier is built into this home-dialysis code. Select it by the patient’s age, home-dialysis status, and monthly service period.

When is 90967 used instead?

90967 is the related per-day code for a patient younger than 2 years when ESRD-related services cover less than a full month.

Does the number of home dialysis treatments determine units?

No. 90963 represents monthly ESRD-related management, not individual dialysis treatments; document the monthly assessment and management furnished.

How does 90963 differ from 90951?

90963 is for home dialysis and is selected by age and monthly service period. 90951 is an in-center ESRD management code for a patient younger than 2 years with a four-or-more-visit monthly level.

What documentation supports 90963?

Record the patient’s age and home-dialysis status, the month of service, and the clinician’s ESRD-related assessment and management, such as review of the dialysis plan, clinical status, and relevant results.

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 90963PPRRVU2026_Oct_nonQPP.csv, line 11,576 (RVU26D)
Geographic factors for North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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