Both cover implanted spinal or brain drug-pump refill and maintenance. Choose 95991 when the service requires physician skill; 95990 covers services that do not.
On this page
CMS RVU26D · Effective 2026-10-01
95991 in El Centro
Office / nonfacility
$123.75
Base rate per service
Facility setting
$33.70
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Neurology procedure
About 95991: Skilled intrathecal pump refill and maintenance
Report 95991 for a physician-skilled refill and maintenance service on an implanted pump delivering medication into the spinal or brain fluid spaces.
This service covers skilled refill and maintenance of an implanted drug-delivery pump or reservoir serving the intrathecal space or a brain ventricle. The clinician accesses the pump’s refill port, manages the reservoir contents, and replenishes medication. Common examples include intrathecal baclofen therapy for severe spasticity and implanted pumps delivering medication for chronic pain. Pain medicine, neurology, and physical medicine and rehabilitation clinicians may perform the service in an office or outpatient facility.
Select 95991 when the refill and maintenance require a physician’s skill; 95990 is the related code for services not requiring that skill. Document the pump and delivery site, the refill performed, medication and reservoir details, and the skilled work supporting code selection. The refill service is distinct from the medication itself, which may be reported separately when applicable. CMS fee-schedule valuation for this code includes physician work and practice expense, with office and facility practice-expense inputs.
Where the value comes from
- Work RVU0.75 · 22%
- Practice expense (office) RVU2.65 · 76%
- Malpractice RVU0.07 · 2%
7.5K
Medicare services in 2024 · #1619 by national volume
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.
95991 compared with similar codes
Office rates for El Centro, from the same CMS release.
Use 62369 for a programmable pump service that includes electronic analysis and reprogramming along with refill and maintenance, when the service is simple.
Use 62370 for a programmable pump service that includes electronic analysis and reprogramming along with refill and maintenance, when the service is complex.
The same code, a different location
How does El Centro compare?
In Bakersfield, the office rate for 95991 is $123.96—$0.21 higher than the $123.75 rate in El Centro. Both use the same code, release and participation basis.
95991 across payment areas
Same release and payment basis · bars start at $0
El Centro · This locality
$123.75
$123.96
$0.21 higher than El Centro
$123.74
$0.01 lower than El Centro
$123.74
$0.01 lower than El Centro
$123.74
$0.01 lower than El Centro
$8.59 higher than El Centro
$123.74
$0.01 lower than El Centro
Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
Across 109 of 109 CMS payment localities with a supported office rate, 95991 ranges from $102.29 in Arkansas to $156.69 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Merced
California · 95991
Office
$123.74
Facility
$33.69
$0.01 lower than El Centro for the office setting.
Modesto
California · 95991
Office
$123.74
Facility
$33.69
$0.01 lower than El Centro for the office setting.
Napa
California · 95991
Office
$144.48
Facility
$36.18
$20.73 higher than El Centro for the office setting.
Oxnard-Thousand Oaks-Ventura
California · 95991
Office
$131.83
Facility
$34.71
$8.08 higher than El Centro for the office setting.
Redding
California · 95991
Office
$123.74
Facility
$33.69
$0.01 lower than El Centro for the office setting.
Rest Of California
California · 95991
Office
$123.74
Facility
$33.69
$0.01 lower than El Centro for the office setting.
Riverside-San Bernardino-Ontario
California · 95991
Office
$124.51
Facility
$34.45
$0.76 higher than El Centro for the office setting.
Sacramento-Roseville-Folsom
California · 95991
Office
$130.15
Facility
$34.59
$6.40 higher than El Centro for the office setting.
Salinas
California · 95991
Office
$129.67
Facility
$34.44
$5.92 higher than El Centro for the office setting.
San Diego-Chula Vista-Carlsbad
California · 95991
Office
$132.93
Facility
$34.66
$9.18 higher than El Centro for the office setting.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 95991
Office
$153.31
Facility
$37.45
$29.56 higher than El Centro for the office setting.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 95991
Office
$153.23
Facility
$37.37
$29.48 higher than El Centro for the office setting.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 95991
Office
$156.69
Facility
$38.21
$32.94 higher than El Centro for the office setting.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 95991
Office
$156.37
Facility
$37.89
$32.62 higher than El Centro for the office setting.
San Luis Obispo-Paso Robles
California · 95991
Office
$127.55
Facility
$33.96
$3.80 higher than El Centro for the office setting.
Santa Cruz-Watsonville
California · 95991
Office
$134.37
Facility
$34.54
$10.62 higher than El Centro for the office setting.
Santa Maria-Santa Barbara
California · 95991
Office
$130.21
Facility
$34.40
$6.46 higher than El Centro for the office setting.
Santa Rosa-Petaluma
California · 95991
Office
$135.75
Facility
$34.85
$12.00 higher than El Centro for the office setting.
Stockton
California · 95991
Office
$123.74
Facility
$33.69
$0.01 lower than El Centro for the office setting.
Vallejo
California · 95991
Office
$144.36
Facility
$36.07
$20.61 higher than El Centro for the office setting.
Visalia
California · 95991
Office
$123.74
Facility
$33.69
$0.01 lower than El Centro for the office setting.
Yuba City
California · 95991
Office
$123.74
Facility
$33.69
$0.01 lower than El Centro for the office setting.
Dc + Md/Va Suburbs
District of Columbia · 95991
Office
$133.27
Facility
$36.48
$9.52 higher than El Centro for the office setting.
Miami
Florida · 95991
Office
$123.11
Facility
$37.57
$0.64 lower than El Centro for the office setting.
Chicago
Illinois · 95991
Office
$119.55
Facility
$36.97
$4.20 lower than El Centro for the office setting.
Manhattan
New York · 95991
Office
$133.21
Facility
$37.74
$9.46 higher than El Centro for the office setting.
Alaska*
Alaska · 95991
Office
$133.13
Facility
$45.62
$9.38 higher than El Centro for the office setting.
Alabama
Alabama · 95991
Office
$103.82
Facility
$31.93
$19.93 lower than El Centro for the office setting.
Arkansas
Arkansas · 95991
Office
$102.29
Facility
$31.71
$21.46 lower than El Centro for the office setting.
Arizona
Arizona · 95991
Office
$112.82
Facility
$33.20
$10.93 lower than El Centro for the office setting.
Colorado
Colorado · 95991
Office
$121.35
Facility
$33.93
$2.40 lower than El Centro for the office setting.
Connecticut
Connecticut · 95991
Office
$123.71
Facility
$35.22
$0.04 lower than El Centro for the office setting.
Delaware
Delaware · 95991
Office
$114.73
Facility
$33.55
$9.02 lower than El Centro for the office setting.
Fort Lauderdale
Florida · 95991
Office
$118.94
Facility
$35.71
$4.81 lower than El Centro for the office setting.
Rest Of Florida
Florida · 95991
Office
$113.18
Facility
$34.63
$10.57 lower than El Centro for the office setting.
Atlanta
Georgia · 95991
Office
$117.86
Facility
$34.38
$5.89 lower than El Centro for the office setting.
Rest Of Georgia
Georgia · 95991
Office
$106.79
Facility
$33.50
$16.96 lower than El Centro for the office setting.
Hawaii, Guam
Hawaii · 95991
Office
$127.04
Facility
$33.62
$3.29 higher than El Centro for the office setting.
Iowa
Iowa · 95991
Office
$106.97
Facility
$31.79
$16.78 lower than El Centro for the office setting.
Idaho
Idaho · 95991
Office
$107.59
Facility
$32.00
$16.16 lower than El Centro for the office setting.
East St. Louis
Illinois · 95991
Office
$111.19
Facility
$35.60
$12.56 lower than El Centro for the office setting.
Rest Of Illinois
Illinois · 95991
Office
$109.52
Facility
$34.50
$14.23 lower than El Centro for the office setting.
Suburban Chicago
Illinois · 95991
Office
$120.27
Facility
$35.89
$3.48 lower than El Centro for the office setting.
Indiana
Indiana · 95991
Office
$108.24
Facility
$32.07
$15.51 lower than El Centro for the office setting.
Kansas
Kansas · 95991
Office
$106.24
Facility
$31.97
$17.51 lower than El Centro for the office setting.
Kentucky
Kentucky · 95991
Office
$105.88
Facility
$32.83
$17.87 lower than El Centro for the office setting.
New Orleans
Louisiana · 95991
Office
$111.00
Facility
$33.68
$12.75 lower than El Centro for the office setting.
Rest Of Louisiana
Louisiana · 95991
Office
$105.62
Facility
$32.91
$18.13 lower than El Centro for the office setting.
Metropolitan Boston
Massachusetts · 95991
Office
$133.84
Facility
$35.74
$10.09 higher than El Centro for the office setting.
Rest Of Massachusetts
Massachusetts · 95991
Office
$120.52
Facility
$34.00
$3.23 lower than El Centro for the office setting.
Baltimore/Surr. Cntys
Maryland · 95991
Office
$123.32
Facility
$35.15
$0.43 lower than El Centro for the office setting.
Rest Of Maryland
Maryland · 95991
Office
$117.02
Facility
$33.87
$6.73 lower than El Centro for the office setting.
Rest Of Maine
Maine · 95991
Office
$107.94
Facility
$32.34
$15.81 lower than El Centro for the office setting.
Southern Maine
Maine · 95991
Office
$114.24
Facility
$32.82
$9.51 lower than El Centro for the office setting.
Detroit
Michigan · 95991
Office
$114.41
Facility
$35.12
$9.34 lower than El Centro for the office setting.
Rest Of Michigan
Michigan · 95991
Office
$108.50
Facility
$33.48
$15.25 lower than El Centro for the office setting.
Minnesota
Minnesota · 95991
Office
$116.82
Facility
$32.27
$6.93 lower than El Centro for the office setting.
Metropolitan Kansas City
Missouri · 95991
Office
$110.45
Facility
$33.29
$13.30 lower than El Centro for the office setting.
Metropolitan St. Louis
Missouri · 95991
Office
$111.66
Facility
$33.43
$12.09 lower than El Centro for the office setting.
Rest Of Missouri
Missouri · 95991
Office
$103.63
Facility
$32.80
$20.12 lower than El Centro for the office setting.
Mississippi
Mississippi · 95991
Office
$102.99
Facility
$32.24
$20.76 lower than El Centro for the office setting.
Montana**
Montana · 95991
Office
$115.90
Facility
$33.73
$7.85 lower than El Centro for the office setting.
North Carolina
North Carolina · 95991
Office
$109.13
Facility
$32.47
$14.62 lower than El Centro for the office setting.
North Dakota**
North Dakota · 95991
Office
$114.51
Facility
$32.35
$9.24 lower than El Centro for the office setting.
Nebraska
Nebraska · 95991
Office
$107.63
Facility
$31.79
$16.12 lower than El Centro for the office setting.
New Hampshire
New Hampshire · 95991
Office
$119.24
Facility
$33.70
$4.51 lower than El Centro for the office setting.
Northern Nj
New Jersey · 95991
Office
$131.80
Facility
$36.49
$8.05 higher than El Centro for the office setting.
Rest Of New Jersey
New Jersey · 95991
Office
$125.27
Facility
$35.55
$1.52 higher than El Centro for the office setting.
New Mexico
New Mexico · 95991
Office
$109.02
Facility
$33.68
$14.73 lower than El Centro for the office setting.
Nevada**
Nevada · 95991
Office
$115.60
Facility
$33.35
$8.15 lower than El Centro for the office setting.
Nyc Suburbs/Long Island
New York · 95991
Office
$136.24
Facility
$38.54
$12.49 higher than El Centro for the office setting.
Poughkpsie/N Nyc Suburbs
New York · 95991
Office
$125.93
Facility
$35.96
$2.18 higher than El Centro for the office setting.
Queens
New York · 95991
Office
$134.65
Facility
$37.53
$10.90 higher than El Centro for the office setting.
Rest Of New York
New York · 95991
Office
$110.78
Facility
$32.72
$12.97 lower than El Centro for the office setting.
Ohio
Ohio · 95991
Office
$108.22
Facility
$33.20
$15.53 lower than El Centro for the office setting.
Oklahoma
Oklahoma · 95991
Office
$105.91
Facility
$32.53
$17.84 lower than El Centro for the office setting.
Portland
Oregon · 95991
Office
$125.53
Facility
$34.24
$1.78 higher than El Centro for the office setting.
Rest Of Oregon
Oregon · 95991
Office
$114.85
Facility
$33.02
$8.90 lower than El Centro for the office setting.
Metropolitan Philadelphia
Pennsylvania · 95991
Office
$120.43
Facility
$34.90
$3.32 lower than El Centro for the office setting.
Rest Of Pennsylvania
Pennsylvania · 95991
Office
$108.51
Facility
$33.09
$15.24 lower than El Centro for the office setting.
Puerto Rico
Puerto Rico · 95991
Office
$116.84
Facility
$33.77
$6.91 lower than El Centro for the office setting.
Rhode Island
Rhode Island · 95991
Office
$119.05
Facility
$34.17
$4.70 lower than El Centro for the office setting.
South Carolina
South Carolina · 95991
Office
$108.82
Facility
$32.90
$14.93 lower than El Centro for the office setting.
South Dakota**
South Dakota · 95991
Office
$114.35
Facility
$32.18
$9.40 lower than El Centro for the office setting.
Tennessee
Tennessee · 95991
Office
$106.76
Facility
$32.07
$16.99 lower than El Centro for the office setting.
Austin
Texas · 95991
Office
$120.82
Facility
$33.89
$2.93 lower than El Centro for the office setting.
Beaumont
Texas · 95991
Office
$107.77
Facility
$33.00
$15.98 lower than El Centro for the office setting.
Brazoria
Texas · 95991
Office
$114.79
Facility
$33.36
$8.96 lower than El Centro for the office setting.
Dallas
Texas · 95991
Office
$115.44
Facility
$33.60
$8.31 lower than El Centro for the office setting.
Fort Worth
Texas · 95991
Office
$114.59
Facility
$33.57
$9.16 lower than El Centro for the office setting.
Galveston
Texas · 95991
Office
$115.08
Facility
$33.49
$8.67 lower than El Centro for the office setting.
Houston
Texas · 95991
Office
$116.36
Facility
$34.77
$7.39 lower than El Centro for the office setting.
Rest Of Texas
Texas · 95991
Office
$111.16
Facility
$33.18
$12.59 lower than El Centro for the office setting.
Utah
Utah · 95991
Office
$110.35
Facility
$33.12
$13.40 lower than El Centro for the office setting.
Virginia
Virginia · 95991
Office
$113.71
Facility
$32.94
$10.04 lower than El Centro for the office setting.
Virgin Islands
United States Virgin Islands · 95991
Office
$116.84
Facility
$33.77
$6.91 lower than El Centro for the office setting.
Vermont
Vermont · 95991
Office
$113.86
Facility
$32.52
$9.89 lower than El Centro for the office setting.
Rest Of Washington
Washington · 95991
Office
$120.36
Facility
$33.84
$3.39 lower than El Centro for the office setting.
Seattle (King Cnty)
Washington · 95991
Office
$136.82
Facility
$36.00
$13.07 higher than El Centro for the office setting.
Wisconsin
Wisconsin · 95991
Office
$110.57
Facility
$31.85
$13.18 lower than El Centro for the office setting.
West Virginia
West Virginia · 95991
Office
$105.31
Facility
$33.91
$18.44 lower than El Centro for the office setting.
Wyoming**
Wyoming · 95991
Office
$115.29
Facility
$33.13
$8.46 lower than El Centro for the office setting.
See how rates vary across the country
95991 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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.
$102.29
$140.22
Color shows the midpoint of each state’s locality range.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | $133.13 | 1 |
| AL | $103.82 | 1 |
| AR | $102.29 | 1 |
| AZ | $112.82 | 1 |
| CA | $123.74–$156.69 | 29 |
| CO | $121.35 | 1 |
| CT | $123.71 | 1 |
| DC | $133.27 | 1 |
| DE | $114.73 | 1 |
| FL | $113.18–$123.11 | 3 |
| GA | $106.79–$117.86 | 2 |
| GU | $127.04 | 1 |
| HI | $127.04 | 1 |
| IA | $106.97 | 1 |
| ID | $107.59 | 1 |
| IL | $109.52–$120.27 | 4 |
| IN | $108.24 | 1 |
| KS | $106.24 | 1 |
| KY | $105.88 | 1 |
| LA | $105.62–$111.00 | 2 |
| MA | $120.52–$133.84 | 2 |
| MD | $117.02–$133.27 | 3 |
| ME | $107.94–$114.24 | 2 |
| MI | $108.50–$114.41 | 2 |
| MN | $116.82 | 1 |
| MO | $103.63–$111.66 | 3 |
| MS | $102.99 | 1 |
| MT | $115.90 | 1 |
| NC | $109.13 | 1 |
| ND | $114.51 | 1 |
| NE | $107.63 | 1 |
| NH | $119.24 | 1 |
| NJ | $125.27–$131.80 | 2 |
| NM | $109.02 | 1 |
| NV | $115.60 | 1 |
| NY | $110.78–$136.24 | 5 |
| OH | $108.22 | 1 |
| OK | $105.91 | 1 |
| OR | $114.85–$125.53 | 2 |
| PA | $108.51–$120.43 | 2 |
| PR | $116.84 | 1 |
| RI | $119.05 | 1 |
| SC | $108.82 | 1 |
| SD | $114.35 | 1 |
| TN | $106.76 | 1 |
| TX | $107.77–$120.82 | 8 |
| UT | $110.35 | 1 |
| VA | $113.71–$133.27 | 2 |
| VI | $116.84 | 1 |
| VT | $113.86 | 1 |
| WA | $120.36–$136.82 | 2 |
| WI | $110.57 | 1 |
| WV | $105.31 | 1 |
| WY | $115.29 | 1 |
Where does this rate apply?
El Centro is a Medicare payment area. Our Census mapping connects it to 18 cities and communities in California, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Why are the office and facility amounts different?
For 95991 in El Centro, the physician’s office rate is $123.75 and the facility-setting rate is $33.70: a difference of $90.05.
The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 95991 in El Centro. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$136.13
$123.75 × 110% = $136.13
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 95991 in El Centro.
PPRRVU2026_Oct_nonQPP.csv
12,736
- Code
- 95991
- Physician work
- 0.75
- Practice expense
- 2.65
- Malpractice
- 0.07
GPCI2026.csv
10
- Locality
- El Centro
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.541
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.75 | × 1.017 | 0.7627 |
| Practice expense | 2.65 | × 1.096 | 2.9044 |
| Malpractice | 0.07 | × 0.541 | 0.0379 |
| Total RVUs | 3.7050 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, El Centro$123.75
Open 95991 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.75 | 1.017 |
| Practice expense | 2.65 | 1.096 |
| Malpractice | 0.07 | 0.541 |
(0.75 × 1.017 + 2.65 × 1.096 + 0.07 × 0.541) × $33.4009 = $123.75
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.75 | 1.017 |
| Practice expense | 0.19 | 1.096 |
| Malpractice | 0.07 | 0.541 |
(0.75 × 1.017 + 0.19 × 1.096 + 0.07 × 0.541) × $33.4009 = $33.70
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
95991 · Office / nonfacility
$123.75
Effective 2026-10-01
The base rate is $11.46 higher than on 2025-10-01, moving from $112.29 to $123.75 (10.2%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$112.29changed to$123.75
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.77 changed to 0.75
- Practice expense RVU 2.42 changed to 2.65
- Malpractice RVU 0.08 changed to 0.07
- Work GPCI 1.014 changed to 1.017
- Practice expense GPCI 1.093 changed to 1.096
- Malpractice GPCI 0.570 changed to 0.541
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
Earliest loaded release: $112.29
Held through RVU25B, RVU25C, RVU25D.
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
95991 billing questions
How does 95991 differ from 95990?
95991 is for pump refill and maintenance requiring a physician’s skill. Use 95990 when the service does not require that skill.
Does the refill code include the medication?
The code represents the refill and maintenance service, not the medication supply. Report the drug separately when applicable and supported by the documentation.
What details support reporting 95991?
Document the implanted pump and its intrathecal or intraventricular delivery site, the refill and reservoir details, and the physician-skilled work performed.
When should a programmable-pump code be considered instead?
Consider 62369 or 62370 when the service includes electronic analysis, reprogramming, refill, and maintenance of a programmable pump; those codes distinguish simple from complex services.
Is 95991 selected by the drug or the refill amount?
Selection turns on the physician skill required for the refill and maintenance, not the medication name or amount alone.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
