CPT code 90968: ESRD daily care, ages 2–11, partial month2026 Medicare rate & RVUs in Pennsylvania
Reports daily ESRD-related management for a dialysis patient age 2 through 11 when the clinician’s care covers less than a full month.
Medicare pays $17.20–$18.27 for 90968 in the office in Pennsylvania, from Rest of Pennsylvania to Metropolitan Philadelphia, PA. 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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What 90968 covers
A nephrologist or other qualified clinician reports 90968 for ESRD-related management of a dialysis patient age 2 through 11 when care covers less than a full month. A partial month may occur when a patient begins care after a transfer or starts dialysis, or when care ends during the month after a transplant or another change. The service reflects ongoing ESRD management, such as assessing dialysis-related status and coordinating the care plan; it is not a code for each dialysis run.
The payment unit is a day. Report the code for the days of ESRD-related care in the partial-month period, rather than selecting it by dialysis-session count. Documentation should support the patient’s age, the dates of care, why the period is less than a full month, and the ESRD management provided. For a complete month, choose the applicable monthly ESRD service code based on the care setting and monthly visit category.
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 90968 pays more and less in Pennsylvania
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Philadelphia, PA | $18.27 | $18.27 |
| Rest of Pennsylvania | $17.20 | $17.20 |
How the 90968 rate is calculated
Each of 90968’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 · 90968
RVUs × geographic indexes × conversion factor
Work0.34
0.34 RVUs× 1.000 GPCI
Practice expense0.17
0.17 RVUs× 1.000 GPCI
Malpractice0.02
0.02 RVUs× 1.000 GPCI
Adjusted RVUs
0.5300
Conversion factor
$33.4009
Medicare rate
$17.70
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 90968
90968 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 · 90968
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$17.70
- Non-facility (office)
- $17.70
- Facility
- $17.70
Higher because the practice carries its own overhead.
90968 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 90967ESRD servicesPatient younger than 2
- Use 90967 for per-day ESRD-related services when the patient is younger than 2; 90968 is for ages 2 through 11.
- 90969Daily ESRD careAges 12-19
- Use 90969 for per-day services for patients ages 12 through 19. Code 90968 covers ages 2 through 11.
- 90955Monthly ESRD careAges 2–11, 2–3 visits
- 90955 reports full-month ESRD services for ages 2–11 in the 2-to-3-visit category; 90968 is for less than a full month and is reported per day.
- 90964ESRD servicesHome dialysis, ages 2–11
- 90964 is for monthly ESRD services for a home dialysis patient age 2–11. Use 90968 for a partial-month period reported per day.
90968 billing questions
How does 90968 differ from 90967 or 90969?
These per-day codes distinguish patient age: 90968 is for ages 2 through 11, 90967 for patients under 2, and 90969 for ages 12 through 19.
Can 90968 be reported for a full month of care?
No. It represents ESRD-related services for less than a full month. For a complete month, use the applicable monthly ESRD service code.
Is 90968 reported for each dialysis treatment?
No. Its unit is a day of ESRD-related care, not an individual dialysis run or session.
What documentation supports 90968?
Keep the patient’s age, dates of care establishing the partial-month period, and documentation of the ESRD-related management provided.
When might 90955 be used instead?
90955 is a monthly ESRD service code for a patient age 2 through 11 in the 2-to-3-visit category. It is for a full-month service period, unlike 90968.
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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