Billing code 95990: Pump refillMedicare rate & RVUs

Medicare pays $98.20 for 95990 nationally in the office. Local office rates run $83.78–$140.09.

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

What 95990 covers

This service replenishes and maintains an implanted pump or reservoir that delivers medication into the spinal space or brain ventricles. Typical patients include people receiving intrathecal baclofen for severe spasticity or implanted-pump medication for chronic pain. A clinician accesses the pump’s refill port, withdraws or accounts for residual medication as appropriate, adds the prescribed drug, and may check pump status as part of the service. It is commonly performed in an outpatient pain-management, rehabilitation, or neurosurgical setting.

Report 95990 for the pump refill and maintenance service, not simply for a medication injection or an office visit. Documentation should identify the implanted pump and delivery site, medication and amount instilled, relevant residual volume, and the work performed. CMS classifies this as an incident-to service: it may be billed only when performed under physician supervision. CMS assigns no work RVU to the code; its listed RVUs include practice expense and malpractice.

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 95990 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

95990 rates by state

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

How the 95990 rate is calculated

Each of 95990’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 95990

The CMS indicators that decide how 95990 is paid alongside other services.

95990 compared with similar codes

How to choose

95991Pump refill

Both concern implanted spinal or brain drug-pump refill and maintenance. Distinguish 95990’s incident-to, physician-supervised service from 95991 when physician skill is required.

62369Pump management

Consider 62369 for a programmable implanted pump when the performed work meets that code’s electronic-analysis, reprogramming, refill, and maintenance criteria; 95990 describes the pump refill and maintenance service.

62370Pump refill

Use the applicable programmable-pump code when electronic analysis and reprogramming accompany refill and maintenance and the work meets 62370’s criteria, rather than treating the encounter as a refill alone.

Codes related to 95990

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