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

Medicare pays $618.04–$648.23 for 90963 in the office in Oregon, from Rest of Oregon to Portland, OR. 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.

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.

Where 90963 pays more and less in Oregon

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.

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.

90963 compared with similar codes

How to choose

90964ESRD servicesHome dialysis, ages 2–11

Both codes cover monthly ESRD-related management for home dialysis. Use 90963 for patients younger than 2 and 90964 for patients ages 2 through 11.

90967ESRD servicesPatient younger than 2

90963 is the monthly code for a patient younger than 2 receiving home dialysis; 90967 is the per-day option when services cover less than a full month.

90951ESRD monthly careUnder 2 years, 4+ visits

90951 is for in-center ESRD management of a patient younger than 2 at the four-or-more-visit level. 90963 is for monthly management of a home-dialysis patient in that age group.

Codes related to 90963

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

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

Open CMS sourceHow we calculate rates