Billing code 90960: Monthly ESRD servicesMedicare rate & RVUs

Medicare pays $372.75 for 90960 nationally in the office and $372.75 in a hospital or facility. Local office rates run $347.14–$487.96.

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

What 90960 covers

This service covers a full calendar month of professional ESRD management for a patient age 20 or older receiving facility-based dialysis, commonly in-center hemodialysis. A nephrologist or qualified nonphysician practitioner typically reviews dialysis adequacy, laboratory results, anemia treatment, bone-mineral management, fluid status, blood pressure, and vascular access concerns. Face-to-face visits commonly occur at the dialysis facility, with care coordinated with its staff.

Report one unit for the month when at least four qualifying face-to-face visits are documented; the visits do not generate four monthly units. Record each visit's date, practitioner, and ESRD-related assessment or management. Use 90961 or 90962 for a full month with fewer visits, and 90966 for monthly home dialysis management in this age group. For a partial month, such as dialysis initiation or a transplant during the month, consider the age-appropriate per-day ESRD code. Hospitalization alone does not make a month partial. The monthly professional service includes management of ESRD-related problems; dialysis facility services are distinct.

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 90960 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

90960 rates by state

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

How the 90960 rate is calculated

Each of 90960’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 90960

90960 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.

90960 compared with similar codes

How to choose

90961ESRD management

Both describe a full month of facility-based ESRD management for patients age 20 or older. Use 90960 for at least four qualifying visits and 90961 for two or three.

90966Home dialysis

90966 describes monthly ESRD management for a patient age 20 or older on home dialysis. Use 90960 for facility-based dialysis when at least four qualifying visits are furnished.

90970ESRD services

90970 describes per-day ESRD management for a patient age 20 or older during a partial month. 90960 describes a full month with at least four qualifying visits.

90935Hemodialysis

90935 describes a hemodialysis procedure with one evaluation, such as during a hospital stay. 90960 describes monthly professional ESRD management, not an individual dialysis session.

Codes related to 90960

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