CPT code 90965: Home dialysis2026 Medicare rate & RVUs
Monthly ESRD-related physician services for a home dialysis patient ages 12 through 19, covering ongoing clinical management rather than individual dialysis sessions.
Medicare pays $516.04 for 90965 nationally in the office and $516.04 in a hospital or facility. Local office rates run $482.54–$681.67.
Medicare rate · 90965
Home dialysis
- Work RVUs
- 9.8
- Total RVUs
- 15.45
- Global days
- XXX
National rate · 2026
$516.04
Office setting, before claim adjustments.
See every locality for 90965 →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 90965 covers
This code represents a month of ESRD-related physician or qualified health care professional services for a patient ages 12 through 19 who receives dialysis at home. Care may include managing the dialysis prescription, reviewing treatment adequacy and relevant laboratory results, assessing fluid status and complications, and coordinating the patient’s renal care. The service is reported for the patient’s monthly home-dialysis management, not for each dialysis treatment or each contact during the month.
Select this code when the patient’s age and home-dialysis status match the code’s criteria and the practitioner provides the corresponding monthly ESRD-related services. Documentation should support the patient’s age, home treatment status, and clinical management during the month. Report the age-specific sibling for a different age group; when services cover only part of a month, use the applicable per-day code rather than this monthly code.
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 90965 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
$482.54 to $681.67
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $486.26 | $486.26 |
| Alaska* | $681.67 | $681.67 |
| Arizona | $507.93 | $507.93 |
| Arkansas | $482.54 | $482.54 |
| Atlanta | $523.75 | $523.75 |
| Austin | $524.20 | $524.20 |
| Bakersfield | $530.62 | $530.62 |
| Baltimore/Surr. Cntys | $538.34 | $538.34 |
| Beaumont | $499.44 | $499.44 |
| Brazoria | $512.74 | $512.74 |
| Chicago | $545.13 | $545.13 |
| Chico | $528.50 | $528.50 |
| Colorado | $526.38 | $526.38 |
| Connecticut | $539.79 | $539.79 |
| Dallas | $515.47 | $515.47 |
| Dc + Md/Va Suburbs | $566.01 | $566.01 |
| Delaware | $513.63 | $513.63 |
| Detroit | $523.89 | $523.89 |
| East St. Louis | $522.87 | $522.87 |
| El Centro | $528.60 | $528.60 |
| Fort Lauderdale | $534.43 | $534.43 |
| Fort Worth | $514.04 | $514.04 |
| Fresno | $528.50 | $528.50 |
| Galveston | $514.03 | $514.03 |
| Hanford-Corcoran | $528.50 | $528.50 |
| Hawaii, Guam | $530.72 | $530.72 |
| Houston | $525.02 | $525.02 |
| Idaho | $491.99 | $491.99 |
| Indiana | $493.43 | $493.43 |
| Iowa | $489.62 | $489.62 |
| Kansas | $489.91 | $489.91 |
| Kentucky | $495.62 | $495.62 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $553.60 | $553.60 |
| Madera | $528.50 | $528.50 |
| Manhattan | $576.06 | $576.06 |
| Merced | $528.50 | $528.50 |
| Metropolitan Boston | $559.98 | $559.98 |
| Metropolitan Kansas City | $505.29 | $505.29 |
| Metropolitan Philadelphia | $532.72 | $532.72 |
| Metropolitan St. Louis | $507.99 | $507.99 |
| Miami | $553.60 | $553.60 |
| Minnesota | $506.83 | $506.83 |
| Mississippi | $487.37 | $487.37 |
| Modesto | $528.50 | $528.50 |
| Montana** | $516.00 | $516.00 |
| Napa | $580.44 | $580.44 |
| Nebraska | $490.59 | $490.59 |
| Nevada** | $512.87 | $512.87 |
| New Hampshire | $520.45 | $520.45 |
| New Mexico | $506.07 | $506.07 |
| New Orleans | $508.82 | $508.82 |
| North Carolina | $497.51 | $497.51 |
| North Dakota** | $504.14 | $504.14 |
| Northern Nj | $565.02 | $565.02 |
| Nyc Suburbs/Long Island | $586.05 | $586.05 |
| Ohio | $501.53 | $501.53 |
| Oklahoma | $493.53 | $493.53 |
| Oxnard-Thousand Oaks-Ventura | $548.35 | $548.35 |
| Portland | $534.87 | $534.87 |
| Poughkpsie/N Nyc Suburbs | $551.01 | $551.01 |
| Puerto Rico | $517.60 | $517.60 |
| Queens | $576.55 | $576.55 |
| Redding | $528.50 | $528.50 |
| Rest Of California | $528.50 | $528.50 |
| Rest Of Florida | $518.70 | $518.70 |
| Rest Of Georgia | $501.67 | $501.67 |
| Rest Of Illinois | $512.65 | $512.65 |
| Rest Of Louisiana | $495.80 | $495.80 |
| Rest Of Maine | $494.97 | $494.97 |
| Rest Of Maryland | $519.70 | $519.70 |
| Rest Of Massachusetts | $526.15 | $526.15 |
| Rest Of Michigan | $503.95 | $503.95 |
| Rest Of Missouri | $492.25 | $492.25 |
| Rest Of New Jersey | $546.60 | $546.60 |
| Rest Of New York | $501.66 | $501.66 |
| Rest Of Oregon | $509.42 | $509.42 |
| Rest Of Pennsylvania | $501.11 | $501.11 |
| Rest Of Texas | $505.50 | $505.50 |
| Rest Of Washington | $524.45 | $524.45 |
| Rhode Island | $525.67 | $525.67 |
| Riverside-San Bernardino-Ontario | $535.18 | $535.18 |
| Sacramento-Roseville-Folsom | $546.02 | $546.02 |
| Salinas | $543.71 | $543.71 |
| San Diego-Chula Vista-Carlsbad | $549.75 | $549.75 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $605.45 | $605.45 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $604.77 | $604.77 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $617.31 | $617.31 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $614.52 | $614.52 |
| San Luis Obispo-Paso Robles | $535.76 | $535.76 |
| Santa Cruz-Watsonville | $549.88 | $549.88 |
| Santa Maria-Santa Barbara | $543.91 | $543.91 |
| Santa Rosa-Petaluma | $555.02 | $555.02 |
| Seattle (King Cnty) | $567.03 | $567.03 |
| South Carolina | $500.22 | $500.22 |
| South Dakota** | $502.74 | $502.74 |
| Southern Maine | $507.13 | $507.13 |
| Stockton | $528.50 | $528.50 |
| Suburban Chicago | $538.36 | $538.36 |
| Tennessee | $491.42 | $491.42 |
| Utah | $503.88 | $503.88 |
| Vallejo | $579.46 | $579.46 |
| Vermont | $504.46 | $504.46 |
| Virgin Islands | $517.60 | $517.60 |
| Virginia | $507.28 | $507.28 |
| Visalia | $528.50 | $528.50 |
| West Virginia | $502.59 | $502.59 |
| Wisconsin | $495.09 | $495.09 |
| Wyoming** | $510.83 | $510.83 |
| Yuba City | $528.50 | $528.50 |
90965 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.
$482.54
$681.67
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 | $681.67 | 1 |
| AL | $486.26 | 1 |
| AR | $482.54 | 1 |
| AZ | $507.93 | 1 |
| CA | $528.50–$617.31 | 29 |
| CO | $526.38 | 1 |
| CT | $539.79 | 1 |
| DC | $566.01 | 1 |
| DE | $513.63 | 1 |
| FL | $518.70–$553.60 | 3 |
| GA | $501.67–$523.75 | 2 |
| GU | $530.72 | 1 |
| HI | $530.72 | 1 |
| IA | $489.62 | 1 |
| ID | $491.99 | 1 |
| IL | $512.65–$545.13 | 4 |
| IN | $493.43 | 1 |
| KS | $489.91 | 1 |
| KY | $495.62 | 1 |
| LA | $495.80–$508.82 | 2 |
| MA | $526.15–$559.98 | 2 |
| MD | $519.70–$566.01 | 3 |
| ME | $494.97–$507.13 | 2 |
| MI | $503.95–$523.89 | 2 |
| MN | $506.83 | 1 |
| MO | $492.25–$507.99 | 3 |
| MS | $487.37 | 1 |
| MT | $516.00 | 1 |
| NC | $497.51 | 1 |
| ND | $504.14 | 1 |
| NE | $490.59 | 1 |
| NH | $520.45 | 1 |
| NJ | $546.60–$565.02 | 2 |
| NM | $506.07 | 1 |
| NV | $512.87 | 1 |
| NY | $501.66–$586.05 | 5 |
| OH | $501.53 | 1 |
| OK | $493.53 | 1 |
| OR | $509.42–$534.87 | 2 |
| PA | $501.11–$532.72 | 2 |
| PR | $517.60 | 1 |
| RI | $525.67 | 1 |
| SC | $500.22 | 1 |
| SD | $502.74 | 1 |
| TN | $491.42 | 1 |
| TX | $499.44–$525.02 | 8 |
| UT | $503.88 | 1 |
| VA | $507.28–$566.01 | 2 |
| VI | $517.60 | 1 |
| VT | $504.46 | 1 |
| WA | $524.45–$567.03 | 2 |
| WI | $495.09 | 1 |
| WV | $502.59 | 1 |
| WY | $510.83 | 1 |
How the 90965 rate is calculated
Each of 90965’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 · 90965
RVUs × geographic indexes × conversion factor
Work9.80
9.80 RVUs× 1.000 GPCI
Practice expense5.05
5.05 RVUs× 1.000 GPCI
Malpractice0.60
0.60 RVUs× 1.000 GPCI
Adjusted RVUs
15.4500
Conversion factor
$33.4009
Medicare rate
$516.04
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 90965
90965 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 · 90965
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$516.04
- Non-facility (office)
- $516.04
- Facility
- $516.04
Higher because the practice carries its own overhead.
90965 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 90964ESRD services
- Use 90964 for home-dialysis patients ages 2 through 11; 90965 is for ages 12 through 19.
- 90966Home dialysis
- Use 90966 for home-dialysis patients age 20 or older; 90965 is for ages 12 through 19.
- 90969Daily ESRD care
- 90969 reports per-day services for a partial month for a patient ages 12 through 19. Use 90965 for monthly services when the patient’s care covers the month.
- 90957ESRD monthly care
- 90957 belongs to the age 12-through-19 monthly ESRD visit-count series, not the home-dialysis series represented by 90965.
90965 billing questions
How does this differ from 90964 or 90966?
Those codes represent monthly ESRD-related services for home dialysis patients in different age groups: 90964 for ages 2 through 11 and 90966 for age 20 or older. Use 90965 for ages 12 through 19.
Is this billed for each home dialysis treatment?
No. It represents monthly ESRD-related management, not an individual dialysis session.
What if the practitioner provides services for only part of the month?
Use the applicable age-specific per-day code, 90969, for a patient ages 12 through 19 when the service period is less than a full month.
What documentation supports reporting 90965?
Document the patient’s age, home-dialysis status, and the ESRD-related clinical management provided during the month.
When would 90957 be considered instead?
90957 is in the age 12-through-19 ESRD monthly service series based on monthly visit count, rather than the home-dialysis series. Choose the code family that matches the patient’s dialysis situation and services.
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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