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CPT code 90964: ESRD services, home dialysis, ages 2–112026 Medicare rate & RVUs in West Virginia

Report this monthly physician service for ongoing ESRD-related care of a patient ages 2 through 11 who receives dialysis at home.

CMS RVU26DEffective Oct 1, 2026One payment locality605 Medicare services in 2024

In West Virginia, Medicare pays $520.60 for 90964 in the office and $520.60 when it’s performed in a hospital or facility.

$520.60Office (non-facility)
$520.60Hospital or facility
−2.5%vs the national office rate ($534.08)

Check a contract rate as a % of Medicare · 90964 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 90964 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in West Virginia
  2. What 90964 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 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.

How West Virginia compares for 90964

Across 109 of 109 payment localities, the office rate for 90964 runs from $499.92 in Arkansas to $707.08 in Alaska. West Virginia pays $520.60. The RVUs are the same everywhere; the geographic indexes change the dollars.

90964 in West Virginia vs other payment areas
  1. West Virginia · this page$520.60
  2. Los Angeles, CA · California$572.45+$51.85
  3. Washington, DC area · District of Columbia$585.35+$64.75
  4. Miami, FL · Florida$572.76+$52.16
  5. Chicago, IL · Illinois$564.15+$43.55
  6. Manhattan, NY · New York$595.83+$75.23
  7. Alaska · Alaska$707.08+$186.48

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

Every other payment area

90964 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$503.72$503.72
ArkansasArkansas$499.92$499.92
ArizonaArizona$525.80$525.80
Bakersfield, CACalifornia$548.91$548.91
Chico, CACalifornia$546.71$546.71
El Centro, CACalifornia$546.81$546.81
Fresno, CACalifornia$546.71$546.71
Hanford, CACalifornia$546.71$546.71

90964 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.

$499.92

$707.08

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

View every state and territory as a table
90964 office rate range by state
State / territoryOffice rate rangeLocalities
AK$707.081
AL$503.721
AR$499.921
AZ$525.801
CA$546.71–$637.7229
CO$544.601
CT$558.441
DC$585.351
DE$531.651
FL$536.97–$572.763
GA$519.59–$542.012
GU$548.791
HI$548.791
IA$507.061
ID$509.491
IL$530.86–$564.154
IN$510.951
KS$507.391
KY$513.341
LA$513.54–$526.812
MA$544.42–$579.022
MD$537.86–$585.353
ME$512.57–$524.902
MI$521.87–$542.302
MN$524.461
MO$509.94–$525.913
MS$504.901
MT$534.041
NC$515.151
ND$521.781
NE$508.031
NH$538.501
NJ$565.52–$584.422
NM$524.051
NV$530.791
NY$519.38–$606.065
OH$519.371
OK$511.161
OR$527.25–$553.242
PA$518.92–$551.252
PR$535.651
RI$543.991
SC$517.981
SD$520.331
TN$508.931
TX$517.22–$543.418
UT$521.711
VA$525.08–$585.352
VI$535.651
VT$522.141
WA$542.65–$586.232
WI$512.571
WV$520.601
WY$528.701

See 90964 in every payment locality

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

Office or facility?

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.

The exact West Virginia inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

11,577

Code
90964
Physician work
10.25
Practice expense
5.12
Malpractice
0.62

GPCI2026.csv

110

Locality
West Virginia
Physician work
1.000
Practice expense
0.869
Malpractice
1.431
Office calculation for 90964 in West Virginia
ComponentRVULocality factorAdjusted
Physician work10.25× 1.00010.2500
Practice expense5.12× 0.8694.4493
Malpractice0.62× 1.4310.8872
Total RVUs15.5865
Conversion factor× 33.4009

Office rate, West Virginia$520.60

Office: (10.25 × 1 + 5.12 × 0.869 + 0.62 × 1.431) × $33.4009 = $520.60

Facility: (10.25 × 1 + 5.12 × 0.869 + 0.62 × 1.431) × $33.4009 = $520.60

Open 90964 in the RVU calculator

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.

Codes related to 90964

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

Codes related to 90964
CodeHow it relatesOffice range, West Virginia
Same family
90963ESRD management, home dialysis, under age 2Monthly home-dialysis ESRD service code for patients younger than 2.$611.20
90965Home dialysis, ages 12 through 19Monthly home-dialysis ESRD service code for patients ages 12 through 19.$502.59
90966Home dialysis, monthly, age 20 and olderMonthly home-dialysis ESRD service code for patients age 20 and older.$300.56
Used instead
90968ESRD daily care, ages 2–11, partial monthPer-day ESRD service code for home-dialysis patients ages 2 through 11.$17.25
90954ESRD management, age 2–11, four visitsMonthly ESRD service code for ages 2 through 11 in a different dialysis setting and visit-count category.$1,014.78

How 90964 has changed in West Virginia

90964 · Office / nonfacility

$520.60

Effective 2026-10-01

The base rate is $34.43 higher than on 2025-10-01, moving from $486.17 to $520.60 (7.1%).

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

    $486.17changed to$520.60

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 4.54 changed to 5.12
    • Malpractice RVU 0.65 changed to 0.62
    • Practice expense GPCI 0.862 changed to 0.869
    • Malpractice GPCI 1.333 changed to 1.431

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $500.18changed to$486.17

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 4.52 changed to 4.54
    • Malpractice RVU 0.66 changed to 0.65

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $492.02changed to$500.18

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $505.21changed to$492.02

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.46 changed to 4.52
    • Malpractice RVU 0.65 changed to 0.66
    • Practice expense GPCI 0.860 changed to 0.862
    • Malpractice GPCI 1.266 changed to 1.333

  5. January 1, 2023

    RVU23A

    $514.39changed to$505.21

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.47 changed to 4.46
    • Practice expense GPCI 0.858 changed to 0.860
    • Malpractice GPCI 1.198 changed to 1.266

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $515.24changed to$514.39

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 4.37 changed to 4.47
    • Malpractice RVU 0.64 changed to 0.65

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $473.21changed to$515.24

    • Conversion factor 36.0896 changed to 34.8931
    • Work RVU 9.14 changed to 10.25
    • Practice expense RVU 3.82 changed to 4.37
    • Malpractice RVU 0.56 changed to 0.64
    • Practice expense GPCI 0.857 changed to 0.858
    • Malpractice GPCI 1.247 changed to 1.198

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $471.68changed to$473.21

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.79 changed to 3.82
    • Malpractice RVU 0.54 changed to 0.56
    • Malpractice GPCI 1.296 changed to 1.247

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $471.32changed to$471.68

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 3.78 changed to 3.79
    • Malpractice RVU 0.55 changed to 0.54

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $467.92changed to$471.32

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.75 changed to 3.78
    • Malpractice RVU 0.56 changed to 0.55
    • Practice expense GPCI 0.847 changed to 0.857
    • Malpractice GPCI 1.289 changed to 1.296

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $464.90changed to$467.92

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 3.74 changed to 3.75
    • Practice expense GPCI 0.836 changed to 0.847
    • Malpractice GPCI 1.282 changed to 1.289

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $465.36changed to$464.90

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 3.73 changed to 3.74
    • Malpractice RVU 0.54 changed to 0.56

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $463.04changed to$465.36

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $462.58changed to$463.04

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 3.78 changed to 3.73
    • Malpractice RVU 0.50 changed to 0.54
    • Practice expense GPCI 0.832 changed to 0.836
    • Malpractice GPCI 1.256 changed to 1.282

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $448.50changed to$462.58

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 4.11 changed to 3.78
    • Malpractice RVU 0.52 changed to 0.50
    • Practice expense GPCI 0.828 changed to 0.832
    • Malpractice GPCI 1.229 changed to 1.256

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $448.50

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$520.60$520.60RVU26D
2026-07-01$520.60$520.60RVU26C
2026-04-01$520.60$520.60RVU26B
2026-01-01$520.60$520.60RVU26A
2025-10-01$486.17$486.17RVU25D
2025-07-01$486.17$486.17RVU25C
2025-04-01$486.17$486.17RVU25B
2025-01-01$486.17$486.17RVU25A
2024-10-01$500.18$500.18RVU24D
2024-07-01$500.18$500.18RVU24C
2024-04-01$500.18$500.18RVU24B
2024-03-09$500.18$500.18RVU24AR
2024-01-01$492.02$492.02RVU24A
2023-10-01$505.21$505.21RVU23D
2023-07-01$505.21$505.21RVU23C
2023-04-01$505.21$505.21RVU23B
2023-01-01$505.21$505.21RVU23A
2022-10-01$514.39$514.39RVU22D
2022-07-01$514.39$514.39RVU22C
2022-04-01$514.39$514.39RVU22B
2022-01-01$514.39$514.39RVU22A
2021-10-01$515.24$515.24RVU21D
2021-07-01$515.24$515.24RVU21C
2021-04-01$515.24$515.24RVU21B
2021-01-01$515.24$515.24RVU21A
2020-10-01$473.21$473.21RVU20D
2020-07-01$473.21$473.21RVU20C
2020-04-01$473.21$473.21RVU20B
2020-01-01$473.21$473.21RVU20A
2019-10-01$471.68$471.68RVU19D
2019-07-01$471.68$471.68RVU19C
2019-04-01$471.68$471.68RVU19B
2019-01-01$471.68$471.68RVU19A
2018-10-01$471.32$471.32RVU18D
2018-07-01$471.32$471.32RVU18C
2018-04-01$471.32$471.32RVU18B
2018-01-01$471.32$471.32RVU18AR1
2017-10-01$467.92$467.92RVU17D
2017-07-01$467.92$467.92RVU17C
2017-04-01$467.92$467.92RVU17B
2017-01-01$467.92$467.92RVU17A
2016-10-01$464.90$464.90RVU16D
2016-07-01$464.90$464.90RVU16C
2016-04-01$464.90$464.90RVU16B
2016-01-01$464.90$464.90RVU16A
2015-10-01$465.36$465.06RVU15D
2015-07-01$465.36$465.06RVU15C
2015-04-01$463.04$462.74RVU15B
2015-01-01$463.04$462.74RVU15A
2014-10-01$462.58$462.58RVU14D
2014-07-01$462.58$462.58RVU14C
2014-04-01$462.58$462.58RVU14B
2014-01-01$462.58$462.58RVU14A
2013-10-01$448.50$448.50RVU13D
2013-07-01$448.50$448.50RVU13C
2013-04-01$448.50$448.50RVU13B
2013-01-01$448.50$448.50RVU13AR

Price 90964 for an earlier date of service

Where the West Virginia rate applies

West Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 439 cities and communities in West Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Accoville
  • Addison (Webster Springs)
  • Adrian
  • Albright
  • Alderson
  • Alum Creek
  • Amherstdale
  • Anawalt

Browse all communities in West Virginia

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

Show the CMS file lines behind this rate
RVUs for 90964PPRRVU2026_Oct_nonQPP.csv, line 11,577 (RVU26D)
Geographic factors for West VirginiaGPCI2026.csv, line 110 (RVU26D)

Open CMS sourceHow we calculate rates

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