CPT code 90966: Home dialysis, monthly, age 20 and older2026 Medicare rate & RVUs in Florida
Monthly ESRD-related management for a patient age 20 or older receiving dialysis at home, including ongoing assessment and management of the dialysis plan.
Medicare pays $311.33–$333.35 for 90966 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 90966 covers
This code represents a month of ESRD-related management for an adult receiving dialysis at home, such as home hemodialysis or peritoneal dialysis. A nephrologist or other qualified clinician manages the patient’s dialysis care, assessing clinical status and addressing the treatment plan, relevant results, and related care needs. Services may be furnished through an outpatient nephrology practice while the patient performs dialysis at home.
Select the code based on the patient’s age and home dialysis setting, not on the number of monthly visits. Documentation should identify the home modality and support the ESRD-related assessment and management furnished during the month. For a patient age 20 or older whose ESRD services cover only part of a month, consider the age-matched per-day code rather than reporting this monthly service as a visit-count level.
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 90966 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
$311.33 to $333.35
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale, FL | $321.49 | $321.49 |
| Miami, FL | $333.35 | $333.35 |
| Rest of Florida | $311.33 | $311.33 |
How the 90966 rate is calculated
Each of 90966’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 · 90966
RVUs × geographic indexes × conversion factor
Work5.52
5.52 RVUs× 1.000 GPCI
Practice expense3.41
3.41 RVUs× 1.000 GPCI
Malpractice0.36
0.36 RVUs× 1.000 GPCI
Adjusted RVUs
9.2900
Conversion factor
$33.4009
Medicare rate
$310.29
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 90966
90966 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 · 90966
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$310.29
- Non-facility (office)
- $310.29
- Facility
- $310.29
Higher because the practice carries its own overhead.
90966 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 90965Home dialysisAges 12 through 19
- Both cover monthly home dialysis management, but 90965 is for patients ages 12 through 19; 90966 is for patients age 20 or older.
- 90970ESRD servicesPer day, age 20 or older
- 90970 reports ESRD services per day for patients age 20 or older when care covers part of a month; 90966 is the monthly home dialysis code.
- 90960Monthly ESRD servicesAge 20+, four or more visits
- 90960 is for in-center ESRD management at the four-or-more-visit level for patients age 20 or older. 90966 is for home dialysis management and is not selected by visit count.
- 90962ESRD monthly careOne visit, age 20+
- 90962 is for in-center ESRD management at the one-visit level for patients age 20 or older. 90966 applies to monthly home dialysis management.
90966 billing questions
Does the number of visits during the month determine whether 90966 applies?
No. The monthly home dialysis code is selected by age and dialysis setting, rather than by the visit-count levels used for in-center ESRD services.
How does 90966 differ from 90965?
Both are monthly home dialysis management codes; 90966 is for patients age 20 or older, while 90965 is for patients ages 12 through 19.
What code is used when home dialysis services cover only part of a month?
For a patient age 20 or older, the per-day counterpart is 90970. Use the code that reflects the patient’s age and the service period.
Is 90966 for home hemodialysis, peritoneal dialysis, or both?
It applies to home dialysis management, including home hemodialysis and peritoneal dialysis.
What should the record support?
Document the patient’s age, home dialysis modality, month of management, and the ESRD-related assessment and management provided.
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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