CPT code 90969: Daily ESRD care, ages 12-192026 Medicare rate & RVUs in Louisiana
Reports ESRD-related services provided to a patient ages 12 through 19 for each covered day when care spans less than a full month.
Medicare pays $16.69–$17.12 for 90969 in the office in Louisiana, from Rest of Louisiana to New Orleans, LA. 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 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 in Louisiana
| Payment locality | Office | Facility |
|---|---|---|
| New Orleans, LA | $17.12 | $17.12 |
| Rest of Louisiana | $16.69 | $16.69 |
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.
How the rate is built · 90969
RVUs × geographic indexes × conversion factor
Work0.33
0.33 RVUs× 1.000 GPCI
Practice expense0.17
0.17 RVUs× 1.000 GPCI
Malpractice0.02
0.02 RVUs× 1.000 GPCI
Adjusted RVUs
0.5200
Conversion factor
$33.4009
Medicare rate
$17.37
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
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.
Place of service · 90969
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$17.37
- Non-facility (office)
- $17.37
- Facility
- $17.37
Higher because the practice carries its own overhead.
90969 compared with similar codes
Compare codes · National
4 codes, side by side
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.
90969 billing questions
When is 90969 appropriate instead of a monthly ESRD code?
Use 90969 when ESRD-related care for a patient ages 12 through 19 covers less than a full month. A full month of care is reported with the applicable monthly code, selected by the patient’s age, treatment context, and visit count.
How many units should be reported?
Report one unit for each day of ESRD-related services furnished during the partial month. Keep documentation supporting the service dates.
Does the number of visits determine whether 90969 applies?
No. This code is for daily services during less than a full month of care; monthly ESRD codes use face-to-face visit counts to distinguish levels.
Which code applies to a patient age 20 or older?
For a patient age 20 or older receiving ESRD-related services for less than a full month, use 90970 rather than 90969.
How does 90969 differ from 90965?
90969 reports daily ESRD-related services during a partial month for a patient ages 12 through 19. Code 90965 is for home dialysis services over a full month in that age group.
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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