CPT code 90965: Home dialysis, ages 12 through 192026 Medicare rate & RVUs in West Virginia
Monthly ESRD-related physician services for a home dialysis patient ages 12 through 19, covering ongoing clinical management rather than individual dialysis sessions.
In West Virginia, Medicare pays $502.59 for 90965 in the office and $502.59 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 90965 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 90965 covers
This code represents a month of ESRD-related physician or qualified health care professional services for a patient ages 12 through 19 who receives dialysis at home. Care may include managing the dialysis prescription, reviewing treatment adequacy and relevant laboratory results, assessing fluid status and complications, and coordinating the patient’s renal care. The service is reported for the patient’s monthly home-dialysis management, not for each dialysis treatment or each contact during the month.
Select this code when the patient’s age and home-dialysis status match the code’s criteria and the practitioner provides the corresponding monthly ESRD-related services. Documentation should support the patient’s age, home treatment status, and clinical management during the month. Report the age-specific sibling for a different age group; when services cover only part of a month, use the applicable per-day code rather than this monthly code.
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 90965
Across 109 of 109 payment localities, the office rate for 90965 runs from $482.54 in Arkansas to $681.67 in Alaska. West Virginia pays $502.59. The RVUs are the same everywhere; the geographic indexes change the dollars.
- West Virginia · this page$502.59
- Los Angeles, CA · California$553.60+$51.01
- Washington, DC area · District of Columbia$566.01+$63.42
- Miami, FL · Florida$553.60+$51.01
- Chicago, IL · Illinois$545.13+$42.54
- Manhattan, NY · New York$576.06+$73.47
- Alaska · Alaska$681.67+$179.08
Other areas in West Virginia first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $486.26 | $486.26 |
| ArkansasArkansas | $482.54 | $482.54 |
| ArizonaArizona | $507.93 | $507.93 |
| Bakersfield, CACalifornia | $530.62 | $530.62 |
| Chico, CACalifornia | $528.50 | $528.50 |
| El Centro, CACalifornia | $528.60 | $528.60 |
| Fresno, CACalifornia | $528.50 | $528.50 |
| Hanford, CACalifornia | $528.50 | $528.50 |
| Madera, CACalifornia | $528.50 | $528.50 |
| Merced, CACalifornia | $528.50 | $528.50 |
| Modesto, CACalifornia | $528.50 | $528.50 |
| Napa, CACalifornia | $580.44 | $580.44 |
| Oxnard, CACalifornia | $548.35 | $548.35 |
| Redding, CACalifornia | $528.50 | $528.50 |
| Rest of CaliforniaCalifornia | $528.50 | $528.50 |
| Riverside, CACalifornia | $535.18 | $535.18 |
| Sacramento, CACalifornia | $546.02 | $546.02 |
| Salinas, CACalifornia | $543.71 | $543.71 |
| San Diego, CACalifornia | $549.75 | $549.75 |
| Marin County, CACalifornia | $605.45 | $605.45 |
| San Francisco, CACalifornia | $604.77 | $604.77 |
| San Benito County, CACalifornia | $617.31 | $617.31 |
| Santa Clara County, CACalifornia | $614.52 | $614.52 |
| San Luis Obispo, CACalifornia | $535.76 | $535.76 |
| Santa Cruz, CACalifornia | $549.88 | $549.88 |
| Santa Maria, CACalifornia | $543.91 | $543.91 |
| Santa Rosa, CACalifornia | $555.02 | $555.02 |
| Stockton, CACalifornia | $528.50 | $528.50 |
| Vallejo, CACalifornia | $579.46 | $579.46 |
| Visalia, CACalifornia | $528.50 | $528.50 |
| Yuba City, CACalifornia | $528.50 | $528.50 |
| ColoradoColorado | $526.38 | $526.38 |
| ConnecticutConnecticut | $539.79 | $539.79 |
| DelawareDelaware | $513.63 | $513.63 |
| Fort Lauderdale, FLFlorida | $534.43 | $534.43 |
| Rest of FloridaFlorida | $518.70 | $518.70 |
| Atlanta, GAGeorgia | $523.75 | $523.75 |
| Rest of GeorgiaGeorgia | $501.67 | $501.67 |
| Hawaii, Guam, HIHawaii | $530.72 | $530.72 |
| IowaIowa | $489.62 | $489.62 |
| IdahoIdaho | $491.99 | $491.99 |
| East St. Louis, ILIllinois | $522.87 | $522.87 |
| Rest of IllinoisIllinois | $512.65 | $512.65 |
| Suburban Chicago, ILIllinois | $538.36 | $538.36 |
| IndianaIndiana | $493.43 | $493.43 |
| KansasKansas | $489.91 | $489.91 |
| KentuckyKentucky | $495.62 | $495.62 |
| New Orleans, LALouisiana | $508.82 | $508.82 |
| Rest of LouisianaLouisiana | $495.80 | $495.80 |
| Metropolitan Boston, MAMassachusetts | $559.98 | $559.98 |
| Rest of MassachusettsMassachusetts | $526.15 | $526.15 |
| Baltimore area, MDMaryland | $538.34 | $538.34 |
| Rest of MarylandMaryland | $519.70 | $519.70 |
| Rest of MaineMaine | $494.97 | $494.97 |
| Southern Maine, MEMaine | $507.13 | $507.13 |
| Detroit, MIMichigan | $523.89 | $523.89 |
| Rest of MichiganMichigan | $503.95 | $503.95 |
| MinnesotaMinnesota | $506.83 | $506.83 |
| Metropolitan Kansas City, MOMissouri | $505.29 | $505.29 |
| Metropolitan St. Louis, MOMissouri | $507.99 | $507.99 |
| Rest of MissouriMissouri | $492.25 | $492.25 |
| MississippiMississippi | $487.37 | $487.37 |
| MontanaMontana | $516.00 | $516.00 |
| North CarolinaNorth Carolina | $497.51 | $497.51 |
| North DakotaNorth Dakota | $504.14 | $504.14 |
| NebraskaNebraska | $490.59 | $490.59 |
| New HampshireNew Hampshire | $520.45 | $520.45 |
| Northern New JerseyNew Jersey | $565.02 | $565.02 |
| Rest of New JerseyNew Jersey | $546.60 | $546.60 |
| New MexicoNew Mexico | $506.07 | $506.07 |
| NevadaNevada | $512.87 | $512.87 |
| NYC suburbs and Long Island, NYNew York | $586.05 | $586.05 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $551.01 | $551.01 |
| Queens, NYNew York | $576.55 | $576.55 |
| Rest of New YorkNew York | $501.66 | $501.66 |
| OhioOhio | $501.53 | $501.53 |
| OklahomaOklahoma | $493.53 | $493.53 |
| Portland, OROregon | $534.87 | $534.87 |
| Rest of OregonOregon | $509.42 | $509.42 |
| Metropolitan Philadelphia, PAPennsylvania | $532.72 | $532.72 |
| Rest of PennsylvaniaPennsylvania | $501.11 | $501.11 |
| Puerto RicoPuerto Rico | $517.60 | $517.60 |
| Rhode IslandRhode Island | $525.67 | $525.67 |
| South CarolinaSouth Carolina | $500.22 | $500.22 |
| South DakotaSouth Dakota | $502.74 | $502.74 |
| TennesseeTennessee | $491.42 | $491.42 |
| Austin, TXTexas | $524.20 | $524.20 |
| Beaumont, TXTexas | $499.44 | $499.44 |
| Brazoria, TXTexas | $512.74 | $512.74 |
| Dallas, TXTexas | $515.47 | $515.47 |
| Fort Worth, TXTexas | $514.04 | $514.04 |
| Galveston, TXTexas | $514.03 | $514.03 |
| Houston, TXTexas | $525.02 | $525.02 |
| Rest of TexasTexas | $505.50 | $505.50 |
| UtahUtah | $503.88 | $503.88 |
| VirginiaVirginia | $507.28 | $507.28 |
| Virgin Islands, VIUnited States Virgin Islands | $517.60 | $517.60 |
| VermontVermont | $504.46 | $504.46 |
| Rest of WashingtonWashington | $524.45 | $524.45 |
| King County, WAWashington | $567.03 | $567.03 |
| WisconsinWisconsin | $495.09 | $495.09 |
| WyomingWyoming | $510.83 | $510.83 |
90965 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$482.54
$681.67
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $681.67 | 1 |
| AL | $486.26 | 1 |
| AR | $482.54 | 1 |
| AZ | $507.93 | 1 |
| CA | $528.50–$617.31 | 29 |
| CO | $526.38 | 1 |
| CT | $539.79 | 1 |
| DC | $566.01 | 1 |
| DE | $513.63 | 1 |
| FL | $518.70–$553.60 | 3 |
| GA | $501.67–$523.75 | 2 |
| GU | $530.72 | 1 |
| HI | $530.72 | 1 |
| IA | $489.62 | 1 |
| ID | $491.99 | 1 |
| IL | $512.65–$545.13 | 4 |
| IN | $493.43 | 1 |
| KS | $489.91 | 1 |
| KY | $495.62 | 1 |
| LA | $495.80–$508.82 | 2 |
| MA | $526.15–$559.98 | 2 |
| MD | $519.70–$566.01 | 3 |
| ME | $494.97–$507.13 | 2 |
| MI | $503.95–$523.89 | 2 |
| MN | $506.83 | 1 |
| MO | $492.25–$507.99 | 3 |
| MS | $487.37 | 1 |
| MT | $516.00 | 1 |
| NC | $497.51 | 1 |
| ND | $504.14 | 1 |
| NE | $490.59 | 1 |
| NH | $520.45 | 1 |
| NJ | $546.60–$565.02 | 2 |
| NM | $506.07 | 1 |
| NV | $512.87 | 1 |
| NY | $501.66–$586.05 | 5 |
| OH | $501.53 | 1 |
| OK | $493.53 | 1 |
| OR | $509.42–$534.87 | 2 |
| PA | $501.11–$532.72 | 2 |
| PR | $517.60 | 1 |
| RI | $525.67 | 1 |
| SC | $500.22 | 1 |
| SD | $502.74 | 1 |
| TN | $491.42 | 1 |
| TX | $499.44–$525.02 | 8 |
| UT | $503.88 | 1 |
| VA | $507.28–$566.01 | 2 |
| VI | $517.60 | 1 |
| VT | $504.46 | 1 |
| WA | $524.45–$567.03 | 2 |
| WI | $495.09 | 1 |
| WV | $502.59 | 1 |
| WY | $510.83 | 1 |
How the 90965 rate is calculated
Each of 90965’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 · 90965
RVUs × geographic indexes × conversion factor
Work9.80
9.80 RVUs× 1.000 GPCI
Practice expense5.05
5.05 RVUs× 1.000 GPCI
Malpractice0.60
0.60 RVUs× 1.000 GPCI
Adjusted RVUs
15.4500
Conversion factor
$33.4009
Medicare rate
$516.04
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
11,578
- Code
- 90965
- Physician work
- 9.80
- Practice expense
- 5.05
- Malpractice
- 0.60
GPCI2026.csv
110
- Locality
- West Virginia
- Physician work
- 1.000
- Practice expense
- 0.869
- Malpractice
- 1.431
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.80 | × 1.000 | 9.8000 |
| Practice expense | 5.05 | × 0.869 | 4.3884 |
| Malpractice | 0.60 | × 1.431 | 0.8586 |
| Total RVUs | 15.0470 | ||
| Conversion factor | × 33.4009 | ||
Office rate, West Virginia$502.59
Office: (9.8 × 1 + 5.05 × 0.869 + 0.6 × 1.431) × $33.4009 = $502.59
Facility: (9.8 × 1 + 5.05 × 0.869 + 0.6 × 1.431) × $33.4009 = $502.59
Payment rules and modifiers for 90965
90965 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 · 90965
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$516.04
- Non-facility (office)
- $516.04
- Facility
- $516.04
Higher because the practice carries its own overhead.
How 90965 has changed in West Virginia
90965 · Office / nonfacility
$502.59
Effective 2026-10-01
The base rate is $34.63 higher than on 2025-10-01, moving from $467.96 to $502.59 (7.4%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$467.96changed to$502.59
- Conversion factor 32.3465 changed to 33.4009
- Practice expense RVU 4.44 changed to 5.05
- Malpractice RVU 0.63 changed to 0.60
- Practice expense GPCI 0.862 changed to 0.869
- Malpractice GPCI 1.333 changed to 1.431
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$479.69changed to$467.96
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 4.39 changed to 4.44
- Malpractice RVU 0.62 changed to 0.63
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$471.86changed to$479.69
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$483.30changed to$471.86
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 4.32 changed to 4.39
- Malpractice RVU 0.59 changed to 0.62
- Practice expense GPCI 0.860 changed to 0.862
- Malpractice GPCI 1.266 changed to 1.333
January 1, 2023
RVU23A
$494.01changed to$483.30
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 4.35 changed to 4.32
- Malpractice RVU 0.62 changed to 0.59
- Practice expense GPCI 0.858 changed to 0.860
- Malpractice GPCI 1.198 changed to 1.266
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$495.41changed to$494.01
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 4.26 changed to 4.35
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$451.91changed to$495.41
- Conversion factor 36.0896 changed to 34.8931
- Work RVU 8.69 changed to 9.80
- Practice expense RVU 3.70 changed to 4.26
- Malpractice RVU 0.53 changed to 0.62
- Practice expense GPCI 0.857 changed to 0.858
- Malpractice GPCI 1.247 changed to 1.198
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$449.11changed to$451.91
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 3.63 changed to 3.70
- Malpractice RVU 0.51 changed to 0.53
- Malpractice GPCI 1.296 changed to 1.247
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$448.01changed to$449.11
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 3.61 changed to 3.63
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$445.06changed to$448.01
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 3.59 changed to 3.61
- Malpractice RVU 0.52 changed to 0.51
- Practice expense GPCI 0.847 changed to 0.857
- Malpractice GPCI 1.289 changed to 1.296
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$442.17changed to$445.06
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 3.58 changed to 3.59
- Practice expense GPCI 0.836 changed to 0.847
- Malpractice GPCI 1.282 changed to 1.289
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$443.60changed to$442.17
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 3.59 changed to 3.58
- Malpractice RVU 0.51 changed to 0.52
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$441.39changed to$443.60
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$438.85changed to$441.39
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 3.57 changed to 3.59
- Malpractice RVU 0.47 changed to 0.51
- Practice expense GPCI 0.832 changed to 0.836
- Malpractice GPCI 1.256 changed to 1.282
Held through RVU15B.
January 1, 2014
RVU14A
$426.30changed to$438.85
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 3.91 changed to 3.57
- Malpractice RVU 0.49 changed to 0.47
- Practice expense GPCI 0.828 changed to 0.832
- Malpractice GPCI 1.229 changed to 1.256
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $426.30
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $502.59 | $502.59 | RVU26D |
| 2026-07-01 | $502.59 | $502.59 | RVU26C |
| 2026-04-01 | $502.59 | $502.59 | RVU26B |
| 2026-01-01 | $502.59 | $502.59 | RVU26A |
| 2025-10-01 | $467.96 | $467.96 | RVU25D |
| 2025-07-01 | $467.96 | $467.96 | RVU25C |
| 2025-04-01 | $467.96 | $467.96 | RVU25B |
| 2025-01-01 | $467.96 | $467.96 | RVU25A |
| 2024-10-01 | $479.69 | $479.69 | RVU24D |
| 2024-07-01 | $479.69 | $479.69 | RVU24C |
| 2024-04-01 | $479.69 | $479.69 | RVU24B |
| 2024-03-09 | $479.69 | $479.69 | RVU24AR |
| 2024-01-01 | $471.86 | $471.86 | RVU24A |
| 2023-10-01 | $483.30 | $483.30 | RVU23D |
| 2023-07-01 | $483.30 | $483.30 | RVU23C |
| 2023-04-01 | $483.30 | $483.30 | RVU23B |
| 2023-01-01 | $483.30 | $483.30 | RVU23A |
| 2022-10-01 | $494.01 | $494.01 | RVU22D |
| 2022-07-01 | $494.01 | $494.01 | RVU22C |
| 2022-04-01 | $494.01 | $494.01 | RVU22B |
| 2022-01-01 | $494.01 | $494.01 | RVU22A |
| 2021-10-01 | $495.41 | $495.41 | RVU21D |
| 2021-07-01 | $495.41 | $495.41 | RVU21C |
| 2021-04-01 | $495.41 | $495.41 | RVU21B |
| 2021-01-01 | $495.41 | $495.41 | RVU21A |
| 2020-10-01 | $451.91 | $451.91 | RVU20D |
| 2020-07-01 | $451.91 | $451.91 | RVU20C |
| 2020-04-01 | $451.91 | $451.91 | RVU20B |
| 2020-01-01 | $451.91 | $451.91 | RVU20A |
| 2019-10-01 | $449.11 | $449.11 | RVU19D |
| 2019-07-01 | $449.11 | $449.11 | RVU19C |
| 2019-04-01 | $449.11 | $449.11 | RVU19B |
| 2019-01-01 | $449.11 | $449.11 | RVU19A |
| 2018-10-01 | $448.01 | $448.01 | RVU18D |
| 2018-07-01 | $448.01 | $448.01 | RVU18C |
| 2018-04-01 | $448.01 | $448.01 | RVU18B |
| 2018-01-01 | $448.01 | $448.01 | RVU18AR1 |
| 2017-10-01 | $445.06 | $445.06 | RVU17D |
| 2017-07-01 | $445.06 | $445.06 | RVU17C |
| 2017-04-01 | $445.06 | $445.06 | RVU17B |
| 2017-01-01 | $445.06 | $445.06 | RVU17A |
| 2016-10-01 | $442.17 | $442.17 | RVU16D |
| 2016-07-01 | $442.17 | $442.17 | RVU16C |
| 2016-04-01 | $442.17 | $442.17 | RVU16B |
| 2016-01-01 | $442.17 | $442.17 | RVU16A |
| 2015-10-01 | $443.60 | $443.30 | RVU15D |
| 2015-07-01 | $443.60 | $443.30 | RVU15C |
| 2015-04-01 | $441.39 | $441.10 | RVU15B |
| 2015-01-01 | $441.39 | $441.10 | RVU15A |
| 2014-10-01 | $438.85 | $438.85 | RVU14D |
| 2014-07-01 | $438.85 | $438.85 | RVU14C |
| 2014-04-01 | $438.85 | $438.85 | RVU14B |
| 2014-01-01 | $438.85 | $438.85 | RVU14A |
| 2013-10-01 | $426.30 | $426.30 | RVU13D |
| 2013-07-01 | $426.30 | $426.30 | RVU13C |
| 2013-04-01 | $426.30 | $426.30 | RVU13B |
| 2013-01-01 | $426.30 | $426.30 | RVU13AR |
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
90965 billing questions
How does this differ from 90964 or 90966?
Those codes represent monthly ESRD-related services for home dialysis patients in different age groups: 90964 for ages 2 through 11 and 90966 for age 20 or older. Use 90965 for ages 12 through 19.
Is this billed for each home dialysis treatment?
No. It represents monthly ESRD-related management, not an individual dialysis session.
What if the practitioner provides services for only part of the month?
Use the applicable age-specific per-day code, 90969, for a patient ages 12 through 19 when the service period is less than a full month.
What documentation supports reporting 90965?
Document the patient’s age, home-dialysis status, and the ESRD-related clinical management provided during the month.
When would 90957 be considered instead?
90957 is in the age 12-through-19 ESRD monthly service series based on monthly visit count, rather than the home-dialysis series. Choose the code family that matches the patient’s dialysis situation and services.
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
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