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CPT code 90966: Home dialysis, monthly, age 20 and older2026 Medicare rate & RVUs in West Virginia

Monthly ESRD-related management for a patient age 20 or older receiving dialysis at home, including ongoing assessment and management of the dialysis plan.

CMS RVU26DEffective Oct 1, 2026One payment locality296.3K Medicare services in 2024

In West Virginia, Medicare pays $300.56 for 90966 in the office and $300.56 when it’s performed in a hospital or facility.

$300.56Office (non-facility)
$300.56Hospital or facility
−3.1%vs the national office rate ($310.29)

Check a contract rate as a % of Medicare · 90966 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 90966 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in West Virginia
  2. What 90966 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 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.

How West Virginia compares for 90966

Across 109 of 109 payment localities, the office rate for 90966 runs from $288.40 in Arkansas to $404.49 in Alaska. West Virginia pays $300.56. The RVUs are the same everywhere; the geographic indexes change the dollars.

90966 in West Virginia vs other payment areas
  1. West Virginia · this page$300.56
  2. Los Angeles, CA · California$334.66+$34.10
  3. Washington, DC area · District of Columbia$341.88+$41.32
  4. Miami, FL · Florida$333.35+$32.79
  5. Chicago, IL · Illinois$327.73+$27.17
  6. Manhattan, NY · New York$347.59+$47.03
  7. Alaska · Alaska$404.49+$103.93

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

Every other payment area

90966 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$290.84$290.84
ArkansasArkansas$288.40$288.40
ArizonaArizona$305.03$305.03
Bakersfield, CACalifornia$320.03$320.03
Chico, CACalifornia$318.78$318.78
El Centro, CACalifornia$318.84$318.84
Fresno, CACalifornia$318.78$318.78
Hanford, CACalifornia$318.78$318.78

90966 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.

$288.40

$404.49

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

View every state and territory as a table
90966 office rate range by state
State / territoryOffice rate rangeLocalities
AK$404.491
AL$290.841
AR$288.401
AZ$305.031
CA$318.78–$375.3429
CO$317.161
CT$325.281
DC$341.881
DE$308.641
FL$311.33–$333.353
GA$300.30–$315.092
GU$320.841
HI$320.841
IA$293.361
ID$294.851
IL$307.16–$327.734
IN$295.801
KS$293.401
KY$296.631
LA$296.69–$305.212
MA$316.84–$338.632
MD$312.52–$341.883
ME$296.64–$304.832
MI$301.94–$314.562
MN$305.131
MO$294.26–$304.853
MS$291.321
MT$310.271
NC$298.321
ND$303.151
NE$294.051
NH$313.461
NJ$329.31–$340.952
NM$303.261
NV$308.401
NY$301.03–$353.935
OH$300.481
OK$295.431
OR$306.27–$322.812
PA$300.29–$320.602
PR$311.371
RI$316.261
SC$299.831
SD$302.311
TN$294.361
TX$299.19–$315.908
UT$302.231
VA$304.82–$341.882
VI$311.371
VT$303.221
WA$315.85–$343.172
WI$297.191
WV$300.561
WY$307.171

See 90966 in every payment locality

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

Office or facility?

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.

The exact West Virginia inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

11,579

Code
90966
Physician work
5.52
Practice expense
3.41
Malpractice
0.36

GPCI2026.csv

110

Locality
West Virginia
Physician work
1.000
Practice expense
0.869
Malpractice
1.431
Office calculation for 90966 in West Virginia
ComponentRVULocality factorAdjusted
Physician work5.52× 1.0005.5200
Practice expense3.41× 0.8692.9633
Malpractice0.36× 1.4310.5152
Total RVUs8.9985
Conversion factor× 33.4009

Office rate, West Virginia$300.56

Office: (5.52 × 1 + 3.41 × 0.869 + 0.36 × 1.431) × $33.4009 = $300.56

Facility: (5.52 × 1 + 3.41 × 0.869 + 0.36 × 1.431) × $33.4009 = $300.56

Open 90966 in the RVU calculator

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.

Codes related to 90966

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

Codes related to 90966
CodeHow it relatesOffice range, West Virginia
Same family
90963ESRD management, home dialysis, under age 2Monthly home dialysis management for patients younger than 2 years.$611.20
90964ESRD services, home dialysis, ages 2–11Monthly home dialysis management for patients ages 2 through 11.$520.60
90965Home dialysis, ages 12 through 19Monthly home dialysis management for patients ages 12 through 19.$502.59
Used instead
90970ESRD services, per day, age 20 or olderPer-day ESRD services for patients age 20 or older when services cover part of a month.$9.68
90960Monthly ESRD services, age 20+, four or more visitsMonthly in-center ESRD services for patients age 20 or older with four or more visits.$361.62
90961ESRD management, 2-3 visits, age 20+Monthly in-center ESRD services for patients age 20 or older with two or three visits.$300.85
90962ESRD monthly care, one visit, age 20+Monthly in-center ESRD services for patients age 20 or older with one visit.$206.67

How 90966 has changed in West Virginia

90966 · Office / nonfacility

$300.56

Effective 2026-10-01

The base rate is $25.37 higher than on 2025-10-01, moving from $275.19 to $300.56 (9.2%).

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

    $275.19changed to$300.56

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 2.94 changed to 3.41
    • Malpractice RVU 0.34 changed to 0.36
    • 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

    $280.90changed to$275.19

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 2.86 changed to 2.94

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $276.31changed to$280.90

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $282.95changed to$276.31

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.79 changed to 2.86
    • Practice expense GPCI 0.860 changed to 0.862
    • Malpractice GPCI 1.266 changed to 1.333

  5. January 1, 2023

    RVU23A

    $288.26changed to$282.95

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 2.80 changed to 2.79
    • 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

    $288.44changed to$288.26

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 2.74 changed to 2.80
    • Malpractice RVU 0.33 changed to 0.34

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $235.03changed to$288.44

    • Conversion factor 36.0896 changed to 34.8931
    • Work RVU 4.26 changed to 5.52
    • Practice expense RVU 2.25 changed to 2.74
    • Malpractice RVU 0.26 changed to 0.33
    • 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

    $233.30changed to$235.03

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 2.22 changed to 2.25
    • Malpractice RVU 0.24 changed to 0.26
    • Malpractice GPCI 1.296 changed to 1.247

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $233.05changed to$233.30

    • Conversion factor 35.9996 changed to 36.0391

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $230.86changed to$233.05

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.20 changed to 2.22
    • 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

    $229.99changed to$230.86

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 2.22 changed to 2.20
    • 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

    $230.52changed to$229.99

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 2.21 changed to 2.22

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $229.37changed to$230.52

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $230.02changed to$229.37

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 2.22 changed to 2.21
    • Malpractice RVU 0.25 changed to 0.24
    • 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

    $224.83changed to$230.02

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.45 changed to 2.22
    • Malpractice RVU 0.26 changed to 0.25
    • 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: $224.83

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$300.56$300.56RVU26D
2026-07-01$300.56$300.56RVU26C
2026-04-01$300.56$300.56RVU26B
2026-01-01$300.56$300.56RVU26A
2025-10-01$275.19$275.19RVU25D
2025-07-01$275.19$275.19RVU25C
2025-04-01$275.19$275.19RVU25B
2025-01-01$275.19$275.19RVU25A
2024-10-01$280.90$280.90RVU24D
2024-07-01$280.90$280.90RVU24C
2024-04-01$280.90$280.90RVU24B
2024-03-09$280.90$280.90RVU24AR
2024-01-01$276.31$276.31RVU24A
2023-10-01$282.95$282.95RVU23D
2023-07-01$282.95$282.95RVU23C
2023-04-01$282.95$282.95RVU23B
2023-01-01$282.95$282.95RVU23A
2022-10-01$288.26$288.26RVU22D
2022-07-01$288.26$288.26RVU22C
2022-04-01$288.26$288.26RVU22B
2022-01-01$288.26$288.26RVU22A
2021-10-01$288.44$288.44RVU21D
2021-07-01$288.44$288.44RVU21C
2021-04-01$288.44$288.44RVU21B
2021-01-01$288.44$288.44RVU21A
2020-10-01$235.03$235.03RVU20D
2020-07-01$235.03$235.03RVU20C
2020-04-01$235.03$235.03RVU20B
2020-01-01$235.03$235.03RVU20A
2019-10-01$233.30$233.30RVU19D
2019-07-01$233.30$233.30RVU19C
2019-04-01$233.30$233.30RVU19B
2019-01-01$233.30$233.30RVU19A
2018-10-01$233.05$233.05RVU18D
2018-07-01$233.05$233.05RVU18C
2018-04-01$233.05$233.05RVU18B
2018-01-01$233.05$233.05RVU18AR1
2017-10-01$230.86$230.86RVU17D
2017-07-01$230.86$230.86RVU17C
2017-04-01$230.86$230.86RVU17B
2017-01-01$230.86$230.86RVU17A
2016-10-01$229.99$229.99RVU16D
2016-07-01$229.99$229.99RVU16C
2016-04-01$229.99$229.99RVU16B
2016-01-01$229.99$229.99RVU16A
2015-10-01$230.52$230.52RVU15D
2015-07-01$230.52$230.52RVU15C
2015-04-01$229.37$229.37RVU15B
2015-01-01$229.37$229.37RVU15A
2014-10-01$230.02$230.02RVU14D
2014-07-01$230.02$230.02RVU14C
2014-04-01$230.02$230.02RVU14B
2014-01-01$230.02$230.02RVU14A
2013-10-01$224.83$224.83RVU13D
2013-07-01$224.83$224.83RVU13C
2013-04-01$224.83$224.83RVU13B
2013-01-01$224.83$224.83RVU13AR

Price 90966 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

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
RVUs for 90966PPRRVU2026_Oct_nonQPP.csv, line 11,579 (RVU26D)
Geographic factors for West VirginiaGPCI2026.csv, line 110 (RVU26D)

Open CMS sourceHow we calculate rates

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