Billing code 90957: ESRD monthly careMedicare rate & RVUs

Medicare pays $796.95 for 90957 nationally in the office and $796.95 in a hospital or facility. Local office rates run $746.13–$1,056.55.

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

What 90957 covers

Code 90957 represents monthly management of end-stage renal disease for a patient age 12 through 19 who receives four or more face-to-face visits during the month. A nephrologist or other qualified clinician typically provides this care in connection with the patient’s dialysis program. The work may include assessing dialysis adequacy, volume status, nutrition, vascular access, complications, and the ongoing treatment plan, as well as coordinating care with the dialysis team.

Report one monthly service when the age and visit-count criteria are met; this is not a per-dialysis-session code. Documentation should support the patient’s age, the ESRD-related management provided, and at least four face-to-face visits in that calendar month. Select a different monthly code when the patient has fewer qualifying visits, falls into another age band, or receives home dialysis services represented by the home-dialysis series. CMS lists no payment rules for this code in the supplied facts.

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 90957 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

90957 rates by state

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

How the 90957 rate is calculated

Each of 90957’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 90957

90957 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.

90957 compared with similar codes

How to choose

90958ESRD management

Both codes cover monthly ESRD management for ages 12–19. Choose 90957 for four or more face-to-face visits and 90958 for two or three.

90959ESRD monthly care

Both apply to ages 12–19, but 90959 represents one face-to-face visit during the month; 90957 requires four or more.

90960Monthly ESRD services

Both represent monthly ESRD management with four or more face-to-face visits. Code 90960 is for patients age 20 or older, while 90957 is for ages 12–19.

90935Hemodialysis

Code 90935 describes hemodialysis with one evaluation. Code 90957 represents monthly ESRD-related management for a patient ages 12–19 with four or more face-to-face visits.

Codes related to 90957

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