CPT code 90969: Daily ESRD care, ages 12-192026 Medicare rate & RVUs

Medicare pays $17.37 for 90969 nationally in the office and $17.37 in a hospital or facility. Local office rates run $16.24–$22.95.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 90969 covers

Code 90969 represents daily management of end-stage renal disease for a patient who is 12 through 19 years old when the clinician provides care for less than a full month. Nephrologists and other clinicians managing ESRD may report it for a partial month of care, such as when a patient starts or ends care with the practice during the month. It is a daily service code, not a monthly code selected by counting face-to-face visits.

Report the code for each day of ESRD-related services during the partial month, using the patient’s age and the period of care to select the code. The record should support the dates care was furnished, the patient’s age, and the ESRD-related management provided. For a full month of care, use the applicable monthly ESRD service code instead; the monthly code selection depends on the patient’s age, treatment context, and visit count.

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 90969 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

90969 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 90969 rate is calculated

Each of 90969’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.

Payment rules and modifiers for 90969

90969 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.

90969 compared with similar codes

How to choose

90970ESRD servicesPer day, age 20 or older

90969 applies to patients ages 12 through 19 receiving care for less than a full month; 90970 is the corresponding daily code for patients age 20 or older.

90958ESRD managementAge 12-19, 2-3 visits

90958 is a monthly code for patients ages 12 through 19 with two or three face-to-face visits. 90969 is selected for a partial month and reported per day.

90965Home dialysisAges 12 through 19

90965 covers a full month of home dialysis services for patients ages 12 through 19. 90969 is for daily ESRD-related services when care covers less than a full month.

Codes related to 90969

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

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

Open CMS sourceHow we calculate rates