CPT code 90964: ESRD services, home dialysis, ages 2–112026 Medicare rate & RVUs in Florida
Report this monthly physician service for ongoing ESRD-related care of a patient ages 2 through 11 who receives dialysis at home.
Medicare pays $536.97–$572.76 for 90964 in the office in Florida, from Rest of Florida to Miami, FL. 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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On this page 9 sections
What 90964 covers
This code represents a month of physician management for a child ages 2 through 11 receiving home dialysis. A nephrologist typically assesses the child’s dialysis-related status, reviews treatment and laboratory information, and manages issues such as fluid balance, blood pressure, medications, vascular access, and dialysis complications. Care may involve coordination with the family and the home dialysis team in an outpatient setting.
Select the code based on the patient’s age and home-dialysis status for the month. Documentation should support the patient’s age, home dialysis, and the physician’s ESRD-related management during that month. This is a monthly service code, not a code for each home dialysis session. For a partial month, compare the circumstances with the applicable per-day ESRD service code rather than treating this as a per-session 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 90964 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$536.97 to $572.76
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale, FL | $553.04 | $553.04 |
| Miami, FL | $572.76 | $572.76 |
| Rest of Florida | $536.97 | $536.97 |
How the 90964 rate is calculated
Each of 90964’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 · 90964
RVUs × geographic indexes × conversion factor
Work10.25
10.25 RVUs× 1.000 GPCI
Practice expense5.12
5.12 RVUs× 1.000 GPCI
Malpractice0.62
0.62 RVUs× 1.000 GPCI
Adjusted RVUs
15.9900
Conversion factor
$33.4009
Medicare rate
$534.08
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 90964
90964 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 · 90964
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$534.08
- Non-facility (office)
- $534.08
- Facility
- $534.08
Higher because the practice carries its own overhead.
90964 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 90963ESRD managementHome dialysis, under age 2
- Both report monthly ESRD-related services for home dialysis; 90963 is for patients younger than 2, while 90964 is for ages 2 through 11.
- 90965Home dialysisAges 12 through 19
- Both are monthly home-dialysis ESRD service codes. Use 90965 for ages 12 through 19 and 90964 for ages 2 through 11.
- 90968ESRD daily careAges 2–11, partial month
- Code 90968 represents per-day ESRD services for home-dialysis patients ages 2 through 11; 90964 represents the monthly service for that age group.
- 90954ESRD managementAge 2–11, four visits
- Code 90954 applies to a different dialysis setting and visit-count category for patients ages 2 through 11; 90964 is the monthly home-dialysis code.
90964 billing questions
How is 90964 distinguished from 90963 and 90965?
These are monthly home-dialysis ESRD service codes distinguished by patient age. Code 90964 is for ages 2 through 11; 90963 is for patients younger than 2, and 90965 is for ages 12 through 19.
Is 90964 reported for every home dialysis treatment?
No. It represents monthly ESRD-related physician management, not an individual dialysis session.
What documentation supports reporting 90964?
Document the patient’s age, home-dialysis status, and the ESRD-related assessment and management provided during the month.
When should a per-day code be considered instead?
Consider the age-appropriate per-day ESRD service code when the applicable circumstances involve a partial month. Code 90968 is the per-day code for ages 2 through 11.
How does 90964 differ from 90954?
Both relate to patients ages 2 through 11, but 90964 is for home dialysis. Code 90954 is a monthly ESRD service code for a different dialysis setting and visit-count category.
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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