Billing code 90956: ESRD serviceMedicare rate & RVUs
Reports monthly ESRD-related physician services for a patient ages 2–11 when one face-to-face visit is furnished during the month.
Medicare pays $366.74 for 90956 nationally in the office and $366.74 in a hospital or facility. Local office rates run $341.59–$480.02.
Medicare rate · 90956
ESRD service
Swap in your local Medicare rate.
- Work RVUs
- 6.64
- Total RVUs
- 10.98
- Global days
- XXX
National rate · 2026
$366.74
Office setting, before claim adjustments.
See every locality for 90956 → · Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 10 sections
What 90956 covers
This code represents monthly ESRD-related care for a patient who is 2 through 11 years old and receives one face-to-face visit during the month. A nephrologist commonly provides the visit in a dialysis setting, reviewing the child’s clinical course and addressing ESRD management needs such as dialysis tolerance, fluid status, laboratory findings, medications, and growth or nutrition concerns. It represents monthly care, not a separate evaluation for each dialysis treatment.
Select the code by the patient’s age and the number of face-to-face visits furnished in the month. Documentation should support the patient’s age, the date and substance of the visit, and the ESRD-related management performed. Use the corresponding sibling when the monthly visit count or age band differs; the home-dialysis monthly series and per-day services describe different circumstances. CMS assigns physician fee schedule values to this service.
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 90956 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$341.59 to $480.02
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $344.39 | $344.39 |
| Alaska* | $480.02 | $480.02 |
| Arizona | $360.70 | $360.70 |
| Arkansas | $341.59 | $341.59 |
| Atlanta | $372.26 | $372.26 |
| Austin | $373.24 | $373.24 |
| Bakersfield | $378.20 | $378.20 |
| Baltimore/Surr. Cntys | $383.12 | $383.12 |
| Beaumont | $353.96 | $353.96 |
| Brazoria | $364.32 | $364.32 |
| Chicago | $386.68 | $386.68 |
| Chico | $376.76 | $376.76 |
| Colorado | $374.81 | $374.81 |
| Connecticut | $384.16 | $384.16 |
| Dallas | $366.27 | $366.27 |
| Dc + Md/Va Suburbs | $403.63 | $403.63 |
| Delaware | $364.89 | $364.89 |
| Detroit | $371.54 | $371.54 |
| East St. Louis | $370.13 | $370.13 |
| El Centro | $376.83 | $376.83 |
| Fort Lauderdale | $379.51 | $379.51 |
| Fort Worth | $365.13 | $365.13 |
| Fresno | $376.76 | $376.76 |
| Galveston | $365.24 | $365.24 |
| Hanford-Corcoran | $376.76 | $376.76 |
| Hawaii, Guam | $378.96 | $378.96 |
| Houston | $372.75 | $372.75 |
| Idaho | $349.02 | $349.02 |
| Indiana | $350.12 | $350.12 |
| Iowa | $347.33 | $347.33 |
| Kansas | $347.35 | $347.35 |
| Kentucky | $351.01 | $351.01 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $395.26 | $395.26 |
| Madera | $376.76 | $376.76 |
| Manhattan | $410.23 | $410.23 |
| Merced | $376.76 | $376.76 |
| Metropolitan Boston | $399.79 | $399.79 |
| Metropolitan Kansas City | $358.42 | $358.42 |
| Metropolitan Philadelphia | $378.76 | $378.76 |
| Metropolitan St. Louis | $360.47 | $360.47 |
| Miami | $393.06 | $393.06 |
| Minnesota | $360.91 | $360.91 |
| Mississippi | $344.92 | $344.92 |
| Modesto | $376.76 | $376.76 |
| Montana** | $366.71 | $366.71 |
| Napa | $415.72 | $415.72 |
| Nebraska | $348.12 | $348.12 |
| Nevada** | $364.59 | $364.59 |
| New Hampshire | $370.41 | $370.41 |
| New Mexico | $358.60 | $358.60 |
| New Orleans | $360.86 | $360.86 |
| North Carolina | $353.00 | $353.00 |
| North Dakota** | $358.61 | $358.61 |
| Northern Nj | $402.65 | $402.65 |
| Nyc Suburbs/Long Island | $417.48 | $417.48 |
| Ohio | $355.43 | $355.43 |
| Oklahoma | $349.64 | $349.64 |
| Oxnard-Thousand Oaks-Ventura | $391.68 | $391.68 |
| Portland | $381.36 | $381.36 |
| Poughkpsie/N Nyc Suburbs | $392.07 | $392.07 |
| Puerto Rico | $367.98 | $367.98 |
| Queens | $410.88 | $410.88 |
| Redding | $376.76 | $376.76 |
| Rest Of California | $376.76 | $376.76 |
| Rest Of Florida | $367.85 | $367.85 |
| Rest Of Georgia | $355.19 | $355.19 |
| Rest Of Illinois | $363.03 | $363.03 |
| Rest Of Louisiana | $351.07 | $351.07 |
| Rest Of Maine | $351.06 | $351.06 |
| Rest Of Maryland | $369.41 | $369.41 |
| Rest Of Massachusetts | $374.47 | $374.47 |
| Rest Of Michigan | $357.09 | $357.09 |
| Rest Of Missouri | $348.27 | $348.27 |
| Rest Of New Jersey | $389.02 | $389.02 |
| Rest Of New York | $356.11 | $356.11 |
| Rest Of Oregon | $362.15 | $362.15 |
| Rest Of Pennsylvania | $355.22 | $355.22 |
| Rest Of Texas | $358.72 | $358.72 |
| Rest Of Washington | $373.31 | $373.31 |
| Rhode Island | $373.81 | $373.81 |
| Riverside-San Bernardino-Ontario | $381.32 | $381.32 |
| Sacramento-Roseville-Folsom | $389.77 | $389.77 |
| Salinas | $388.13 | $388.13 |
| San Diego-Chula Vista-Carlsbad | $392.85 | $392.85 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $434.22 | $434.22 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $433.76 | $433.76 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $442.80 | $442.80 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $440.90 | $440.90 |
| San Luis Obispo-Paso Robles | $382.40 | $382.40 |
| Santa Cruz-Watsonville | $393.27 | $393.27 |
| Santa Maria-Santa Barbara | $388.39 | $388.39 |
| Santa Rosa-Petaluma | $396.97 | $396.97 |
| Seattle (King Cnty) | $405.12 | $405.12 |
| South Carolina | $354.71 | $354.71 |
| South Dakota** | $357.65 | $357.65 |
| Southern Maine | $360.51 | $360.51 |
| Stockton | $376.76 | $376.76 |
| Suburban Chicago | $382.41 | $382.41 |
| Tennessee | $348.46 | $348.46 |
| Utah | $357.47 | $357.47 |
| Vallejo | $415.05 | $415.05 |
| Vermont | $358.66 | $358.66 |
| Virgin Islands | $367.98 | $367.98 |
| Virginia | $360.48 | $360.48 |
| Visalia | $376.76 | $376.76 |
| West Virginia | $355.45 | $355.45 |
| Wisconsin | $351.75 | $351.75 |
| Wyoming** | $363.18 | $363.18 |
| Yuba City | $376.76 | $376.76 |
90956 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$341.59
$480.02
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $480.02 | 1 |
| AL | $344.39 | 1 |
| AR | $341.59 | 1 |
| AZ | $360.70 | 1 |
| CA | $376.76–$442.80 | 29 |
| CO | $374.81 | 1 |
| CT | $384.16 | 1 |
| DC | $403.63 | 1 |
| DE | $364.89 | 1 |
| FL | $367.85–$393.06 | 3 |
| GA | $355.19–$372.26 | 2 |
| GU | $378.96 | 1 |
| HI | $378.96 | 1 |
| IA | $347.33 | 1 |
| ID | $349.02 | 1 |
| IL | $363.03–$386.68 | 4 |
| IN | $350.12 | 1 |
| KS | $347.35 | 1 |
| KY | $351.01 | 1 |
| LA | $351.07–$360.86 | 2 |
| MA | $374.47–$399.79 | 2 |
| MD | $369.41–$403.63 | 3 |
| ME | $351.06–$360.51 | 2 |
| MI | $357.09–$371.54 | 2 |
| MN | $360.91 | 1 |
| MO | $348.27–$360.47 | 3 |
| MS | $344.92 | 1 |
| MT | $366.71 | 1 |
| NC | $353.00 | 1 |
| ND | $358.61 | 1 |
| NE | $348.12 | 1 |
| NH | $370.41 | 1 |
| NJ | $389.02–$402.65 | 2 |
| NM | $358.60 | 1 |
| NV | $364.59 | 1 |
| NY | $356.11–$417.48 | 5 |
| OH | $355.43 | 1 |
| OK | $349.64 | 1 |
| OR | $362.15–$381.36 | 2 |
| PA | $355.22–$378.76 | 2 |
| PR | $367.98 | 1 |
| RI | $373.81 | 1 |
| SC | $354.71 | 1 |
| SD | $357.65 | 1 |
| TN | $348.46 | 1 |
| TX | $353.96–$373.24 | 8 |
| UT | $357.47 | 1 |
| VA | $360.48–$403.63 | 2 |
| VI | $367.98 | 1 |
| VT | $358.66 | 1 |
| WA | $373.31–$405.12 | 2 |
| WI | $351.75 | 1 |
| WV | $355.45 | 1 |
| WY | $363.18 | 1 |
How the 90956 rate is calculated
Each of 90956’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 · 90956
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 6.64Practice expense 3.93Malpractice 0.41
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 90956
90956 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 · 90956
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$366.74
The facility rate would be $366.74 (−$0.00). In a facility, the facility bills its own costs separately.
90956 compared with similar codes
Compare codes
90956 vs 90955 vs 90954 vs 90964 vs 90968: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 90955Monthly ESRD care
- Both codes cover monthly ESRD services for patients ages 2–11. Choose 90956 for one face-to-face visit and 90955 for two or three.
- 90954ESRD management
- This sibling covers the same pediatric age band but represents four or more face-to-face visits during the month.
- 90964ESRD services
- 90964 is the monthly ESRD service code for home dialysis patients ages 2–11; 90956 is selected by the one-visit monthly band.
- 90968ESRD daily care
- 90968 reports ESRD services per day for patients ages 2–11, rather than the monthly service represented by 90956.
90956 billing questions
When is 90956 selected instead of 90955?
Use 90956 for a patient ages 2–11 with one face-to-face visit during the month. Code 90955 represents the same age band when two or three visits are furnished.
Does this code represent each dialysis treatment?
No. It represents monthly ESRD-related services and is selected by monthly face-to-face visit count, not by the number of dialysis sessions.
What documentation supports reporting 90956?
Record the patient’s age, the face-to-face visit date, and the ESRD-related assessment and management performed during the visit.
Can 90956 be used for a partial month?
The code describes monthly services with one visit. Per-day ESRD services are represented by a separate code series for partial-month circumstances.
Is 90956 the monthly code for home dialysis?
No. The ESRD monthly series has a separate code for home dialysis patients ages 2–11; select according to the applicable patient and service circumstances.
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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